,,backwoods ,,surgery ,,backwoods ,,surgery ,,medicine ,,by ,,charles ,,stuart ,,moody1 ,m4 ,d4 ,,mcmx ,,outing ,,publishing ,,company ,,new ,,york ,,copyright1 #aiaj1 ,,by ,,outing ,,publishing ,,company ,entered at ,stationer's ,hall1 ,london1 ,eng4 ,all rights reserved ,,contents ,,chapter ,,page ,i4 ,how to ,treat ,fractures1 ,sprains and ,dislocations #i ,,ii4 ,caring for ,burns1 ,cuts1 ,drowning1 and ,minor ,accidents #bi ,,iii4 ,medical ,treatment of ,camp ,diseases #ea ,,iv4 ,serpent ,wounds and ,their ,treatment #gc ,the ,camper's ,medicine ,chest #ic ,,how ,,to ,,treat ,,fractures1 ,,sprains ,,and ,,dislocations ,backwoods ,surgery and ,medicine ,,chapter ,i ,,how ,,to ,,treat ,,fractures1 ,,sprains ,,and ,,dislocations ,several years ago ,i stood beside a cot in a hunter's cabin in the heart of the ,bitter ,root ,mountains in ,idaho1 after a three days' ride1 and watched a valuable young life go out as the result of an unattended compound fracture of the thigh4 ,at another time ,i amputated a leg to prevent the spread of gangrene from a simple cut across the instep while the camper was splitting wood1 an accident which1 properly treated1 would have resulted at most only in a slight inconvenience4 ,once again1 ,i transformed my boat into a funeral barge and conveyed a young man who had only been in the water three minutes back to his sorrowing parents dead1 because his companions were ignorant of how to resuscitate him4 ,these and many other instances that have come under my observation of the sacrifice of lives from trivial causes1 owing to a lack of knowledge1 have impressed me with the value of a few suggestions on how to treat the commoner injuries and diseases that may befall those who seek recreation in the remote wilds4 ,the rules will necessarily be brief and from the nature of things easily followed4 ,the woods loafer should learn them and be prepared whenever the occasion arises4 ,works on first aid1 written ostensibly for the guidance of the laymen1 are apt to presuppose a far greater supply of surgical necessities than the hunter cares to burden himself with4 ,it is one thing to apply surgical measures1 having at hand a well-filled emergency bag1 and quite another to render the same assistance with nothing to depend upon but your native adaptability4 ,my intention is to tell in the plainest and simplest manner possible how to render intelligent assistance to an injured comrade1 using only the fewest appliances and those of the most primitive character4 ,these hints are the result of over twenty years of life in the ,west1 in mining camps1 cow camps1 logging camps1 and in the heart of the mountains1 where people did not have forethought enough to provide themselves with even a bandage1 many times hundreds of miles from where such things could be obtained4 ,the most appalling accident that can befall a man isolated from skilled surgical aid is the fracture of a limb1 especially of the leg1 and yet this is one of the commonest of all woods misfortunes4 ,before proceeding to the discussion of individual fractures1 a brief consideration of the classification and detection of fractures in general is necessary4 ,surgeons divide fractures into3 simple1 those where there is a simple separation of the bone without injury to the flesh2 compound1 where in addition to the separation of the bone there is laceration of the flesh and one or both ends of the bone are driven out through the skin2 and comminuted1 where the bone is in several fragments4 ,a comminuted fracture may be either simple or compound1 according as it does or does not penetrate the flesh4 ,the symptoms of fracture are pain1 loss of motion1 change of position1 change of contour of the fleshy parts1 and most important of all1 a light crackling sound when the limb is moved--crepitation the surgeons call it4 ,pain following an injury that might produce a fracture is not necessarily proof positive of the existence of a fracture4 ,pain may and often does follow a bruise1 sprain1 or dislocation1 in a greater degree than that following a fracture4 ,loss of motion1 too1 is quite as marked in dislocations and severe sprains as in fractures4 ,change of contour1 unless in the locality of prominent joints1 is quite a valuable sign4 ,the fractured limb1 except in certain rare cases1 will show a change in the appearance of its general outline4 ,by crepitation is meant that characteristic grating sound produced by rubbing the two ends of the fractured bone together4 ,it is the one absolute sign of a fracture1 and once heard can never be forgotten4 ,it may be likened to the sound produced by rubbing two or three coarse hairs between the finger and thumb4 ,if a fracture is suspected let the patient himself1 or some one for him1 grasp the limb above and below the site of the suspected fracture and turn it in opposite directions4 ,if a fracture is present it will be manifested by a distinct grating sound1 also by a jarring sensation as the uneven fragments pass over each other4 ,a description of all the fractures of the different bones of the body would be manifestly out of place in a book of this character1 so ,i shall confine myself to those most liable to be encountered in the woods--that is1 fractures of the leg1 thigh1 forearm1 and arm4 ,fractures of the leg or thigh will entail an enforced stay of from four to six weeks in the woods1 or the devising of some means to transport the patient to a place where he can have proper care1 an arduous task in a country where there are no roads and the trails are difficult4 ,if a personal experience may be allowed1 ,i will tell how ,i once treated a man with fractured thigh and conveyed him with comparatively little discomfort over sixteen miles of rugged mountain trail and some forty miles of equally rugged mountain road4 ,i found the man in a mining camp in the very heart of the higher mountains1 lying in his bunk with a badly fractured thigh4 ,the bone was separated between the upper and middle third--that is1 up toward the body4 ,the accident had occurred some twenty hours previous and there was much swelling1 which it was necessary to reduce before anything else could be done4 ,this was accomplished by the application of cold water by means of strips of blanket1 changing the application as fast as the water became warmed by the body heat4 ,in the meantime ,i went out into the timber and felled a small cedar tree some six inches in diameter4 ,from this ,i cut a section five feet in length and removed the bark4 ,splitting the bark in half1 ,i rounded up the edges and made a splint for the outside of the limb extending from the armpit to six inches below the foot4 ,the other half was made into a similar splint1 only shorter1 for the inside of the limb1 extending from well up into the groin to a point opposite the outer splint below the foot4 ,it was necessary to cut holes in the splints where the bony prominences came4 ,when all was in readiness and the limb reduced in size1 ,i wrapped it well in soft cloth1 having no absorbent cotton1 and applied my splints4 ,i had a man stand at the feet of the injured man1 take hold of the injured leg1 and pull steadily while ,i manipulated the fracture4 ,right here ,i want to state that it is unnecessary to try to pull a broken bone out of the socket in order to set a fracture4 ,a persistent pull of some fifty pounds will soon overcome the contraction of the muscles and the bone will be replaced4 ,the acting surgeon must at the same time grasp the limb at the site of the break and knead the two ends into place4 ,you will know when they are in place by the absence of inequality at the point of break4 ,after the bone had been replaced1 ,i placed my splints in position and bound them on1 using strips of sheet torn up for bandages4 ,any stout cloth will do as well4 ,they may be placed in the ordinary manner1 each wrap beside the other1 or they may be run on in continuous form1 permitting each ascending turn to half overlap the one below it4 ,care must be taken that the pressure is equal in all parts of the bandage and that it is placed tight enough to prevent any slipping of the splints4 ,the next problem was to get the man out4 ,again the cedar forest came to my relief4 ,i felled another and somewhat larger tree1 sufficiently large to permit placing the injured man in a boat-shaped section of the bark4 ,this was made longer than his body and a semi-circular board fitted in each end4 ,when the whole was completed it resembled a rude trough4 ,this trough was lined with blankets until it was quite soft4 ,two poles twelve feet in length were lashed to either side and the man securely lashed in the contrivance4 ,when we were ready to start two steady pack animals were brought out and the litter with its burden swung in such manner that the animals could wind down the steep rocky trail with the burden between them4 ,in this manner we jogged down the mountainside all day1 our patient laughing and enjoying his pipe as though he were the guest of honor in some triumphal procession4 ,while cedar was mentioned as having been used in the above case1 the reader will appreciate that any sort of timber with a tough bark will answer equally well4 ,there is one important fact that should always be borne in mind in the treatment of all fractures1 and that is that at least the two adjoining joints should be fixed4 ,if it is the thigh that is fractured1 the hip1 knee1 and ankle should be included in the splint4 ,if the leg1 then the knee and ankle4 ,the same rule holds good with fractures of the forearm or arm4 ,if timber with tough bark is not available1 or in open countries where no timber grows1 a broken bone may be nicely splinted by using small round sticks4 ,never use a clapboard unless it is extremely well padded2 even then it is undesirable from the fact that it is liable to press upon some bony point and cause trouble4 ,also it is very liable to slip and permit your fractured bone to become displaced4 ,to fix a limb by using round sticks1 wrap the limb well in soft cloth2 then1 having cut your sticks the right length1 place them at regular intervals about the limb and bind as before4 ,in the absence of anything better1 two leather gun scabbards make quite effective splints4 ,what has been said with regard to fractures of the lower limb will apply with equal force to breaks of the upper except1 of course1 that the case is one of far less gravity4 ,in cases of fracture of the arm1 either above or below the elbow1 the injured person can make himself quite comfortable by pinning the bottom of his coat to his shoulder and placing the injured arm in the ,v-shaped sling thus formed4 ,the treatment of compound fractures is one that requires some nerve on the part of the acting surgeon and a great deal of fortitude in the injured person4 ,a compound fracture of the leg or thigh is the most terrible accident1 short of death1 that can befall a man in the woods4 ,unless great care is exercised the man will die1 either shortly from septic poisoning1 or almost immediately from shock4 ,first1 get your patient into camp if he is away from it4 ,that may be done in the following manner1 which will also illustrate how to carry a person injured in any manner3 take a blanket and lay it at full length on the ground2 place a pole two feet longer than the blanket directly in the center and fold the blanket over it2 lay a similar pole in the center of the folded half and fold the free side back over2 place your patient on top1 and two men can carry him as comfortably as though he were in a litter4 ,it is1 in fact1 an emergency litter4 ,another emergency litter may be constructed by buttoning an overcoat its full length and running two poles down the sides1 laying the patient between them4 ,failing an overcoat1 two short coats or ,mackinaw jackets may be made to serve4 ,having got your patient with the compound fracture into camp1 cut off all clothing from the wounded limb1 but no more4 ,it is a bad plan to remove too much clothing from badly injured persons4 ,all the warmth must be conserved1 even to the extent of applying artificial heat4 ,examine the wound for foreign matter and carefully remove it1 especially bits of clothing1 leaves1 small sticks1 and bits of earth4 ,while you have been thus engaged1 water should be heated in the cleanest1 brightest vessel the camp affords4 ,if there are none bright enough1 one may be sterilized by burning it over a hot fire for at least ten minutes4 ,it is absolutely essential that the water used to cleanse a wound of this character should be sterile--that is1 without any germ life whatever2 hence the directions for boiling it4 ,in another clean vessel boil all the cloths1 towels1 and other dressings that you intend using4 ,any soft cloth will do for dressings1 provided it is sterilized and sterilization consists only in thorough boiling4 ,one of the articles ,i shall mention in a very limited surgical kit is a bottle of tablets composed of bichloride of mercury known as ,bernay's tablets4 ,they are made by all chemical houses and vary in form1 but all contain about the same quantity of the antiseptic agent4 ,some are white and some blue in color1 the blue being preferable4 ,one of these tablets dissolved in a quart of water makes a solution of about the proper strength for dressing wounds4 ,make your solution and with your sterilized cloths wash out the wound thoroughly1 and that does not mean to let a little water flow over the wound2 it means to remove every particle of foreign matter in and about the wound4 ,if the bones have stuck into the earth1 as is quite often the case1 they must be exposed and the narrow canal cleaned4 ,then replace the bones in as nearly their proper position as possible4 ,do not attempt to set the bone2 just put it back fairly nearly in line4 ,then cover with several layers of moist cloth that have been previously boiled and dipped in the bichloride solution4 ,every day expose the wound1 wash it out1 and dress it4 ,if the patient is of strong physique and ,god smiles1 he may not have septic fever4 ,if1 however1 the limb shows signs of inflammation evidenced by swelling and redness1 accompanied by fever1 chills1 and thirst1 then must you perform some heroic tasks to save your patient's life4 ,remove all dressings and wrap in perfectly clean dressings the entire limb from the hip to the foot1 elevate so that it will drain properly1 and keep cold water running over it in a small stream constantly4 ,this may be done by making a small hole in the side or the bottom of a bucket and hanging it in such a way that it will permit the stream to fall on the limb4 ,if you follow the foregoing directions implicitly1 you have done all that can be done4 ,it will be understood that what ,i have said touches upon the subject of fractures in only a very general way4 ,the methods of treatment outlined will apply to practically any fracture1 and certainly to those most liable to be encountered in the woods4 ,the four principal dislocations that are liable to engage your attention are those of the hip1 knee1 elbow1 and shoulder4 ,of these1 that of the hip is the most serious4 ,without going deeply into the classification of hip-joint dislocation1 it will be sufficient to say that fortunately by far the greater number of these is where the head of the bone slips out of its socket upward and backward4 ,those in which the head of the bone occupies other positions with relation to its socket are much more difficult1 in fact1 for the layman practically impossible4 ,the signs of a hip-joint dislocation are shortening of the limb1 loss of motion1 pain1 and the turning of the toes in toward the opposite foot4 ,you will be able to distinguish it from a fracture of the thigh by the absence of crepitation 7which ,i have described as the slight grating sound made by the broken ends of the bone rubbing together71 and the fact that in a fracture the toes are generally turned out4 ,a friend of mine once reduced his own hip-joint dislocation in a manner that may prove instructive4 ,he was coming down the steep side of a mountain in winter on skees4 ,halfway down the hill1 while he was traveling at a great rate of speed1 he ran into a depression1 breaking his skee and dislocating his hip4 ,it was many miles to the nearest cabin1 night was coming on1 and it was bitterly cold4 ,death stared him in the face4 ,it was a time for the exercise of judgment if ever in his life4 ,he crept down to a grove of small pines1 selected two that were just a little farther apart than the length of his body1 lashed the foot of the injured limb to one with his pack strap1 lay at full length on the snow1 and clasped the other with his arms4 ,pulling with all his might1 he had the satisfaction of hearing the bone jolt back into its socket4 ,the idea suggested will enable the reader to modify the method to suit each individual case4 ,in dislocations of the shoulder the old method still in vogue among some medical men is quite easy of accomplishment4 ,lay the patient on his back and seat yourself at his side1 first having removed the shoe from your foot next to his body4 ,grasp his injured arm and turn it outward from the body4 ,place your bare foot well up into his armpit4 ,while an assistant steadies his shoulder1 pull downward upon his arm1 at the same time moving it toward the patient's body4 ,make your pull steady1 and when you have begun do not relax until you feel the bone jolt into its position4 ,in the case of muscular persons the pull must be kept up for a longer period1 or until the contraction of the muscles has been overcome4 ,dislocations of the elbow are usually those in which the two lower bones slip backward and the upper bone forward4 ,they may be reduced by grasping the injured arm just above the elbow with your left hand1 the fingers just behind the prominence of the dislocation2 with the other hand bend the injured arm well forward1 at the same time slipping your left hand downward4 ,when the injured arm is fully bent1 grasp tightly with your left hand at the elbow joint and with your right forcibly straighten it4 ,the fingers of your left hand form a fulcrum for the bone that is out of place to act upon and thus force it back into position4 ,this maneuver is somewhat difficult to describe but quite easy to accomplish4 ,one will be surprised with what ease the bone slips back into position4 ,dislocations of the knee are reduced similarly1 except that it requires two to do the work4 ,then1 too1 the knee often becomes dislocated laterally and the pressure must be made in a lateral direction4 ,a very distressing little accident is the dislocation of the lower jaw4 ,i once had a patient who rode a long distance with his mouth wide open1 suffering a great deal of inconvenience and no little pain1 when one of his friends could have relieved him in an instant4 ,wrap both your thumbs in several layers of cloth1 stand behind the patient1 who should be seated1 and place your thumbs thus protected1 on his back teeth1 grasp his jaws on either side with your fingers1 press down with your thumbs1 up with your fingers1 at the same time drawing the jaw forward4 ,the bones will go back with a snap and the victim will spasmodically close his mouth hard enough to draw blood unless your thumbs are well shielded4 ,dislocations of the joints of the fingers may be reduced by taking a double half-hitch around the finger below the dislocation with a handkerchief1 placing your left thumb back of the head of the dislocated bone1 and as you pull on the handkerchief with your right hand push forward and downward with your left4 ,the bone will readily slip into place4 ,dislocations should be kept at rest for several days and any tendency toward inflammation kept down by the application of water4 ,severe dislocations1 as those of the hip1 should be treated similarly to fractures4 ,sprains and bruises1 while not serious1 are often very annoying4 ,when the accident first occurs immerse the limb in cold spring water4 ,this has a tendency to contract the small blood vessels and keep down inflammation4 ,if1 however1 swelling has already set in1 hot water should give place to cold1 as hot as can be borne4 ,a consistent application of hot water to a sprain or bruise will ordinarily cure it in a few days4 ,it may be necessary1 under certain conditions1 to bandage the limb1 especially if one has to make a journey4 ,by applying a roller bandage snugly about a sprained ankle1 for instance1 one may travel in comparative comfort for several miles4 ,of course1 he will pay the penalty afterwards1 but ,i am speaking now of cases where it is imperative that a man travel4 ,in applying any bandage be sure that it has no wrinkles in it4 ,it must be laid perfectly smooth and drawn reasonably tight4 ,a loose bandage or one that is placed unevenly is worse than useless4 ,,caring ,,for ,,burns1 ,,cuts1 ,,drowning1 ,,and ,,minor ,,accidents ,,chapter ,,ii ,,caring ,,for ,,burns1 ,,cuts1 ,,drowning1 ,,and ,,minor ,,accidents ,in speaking of fractures and dislocations ,i did not dream it necessary to suggest anything in the way of a surgical kit4 ,the element of instruments other than bandages does not enter largely into the treatment of this class of injuries1 and the bandages may be improvised from materials at hand4 ,in the treatment of such wounds as we shall now take up1 however1 it will be necessary to carry a few things with which to work4 ,this outfit will be limited in its scope1 economy of space being imperative4 ,a convenient instrument roll may be made from a strip of canvas1 with a pocket at the bottom and loops for holding instruments4 ,this can be rolled into compact shape when filled and tied with tape4 ,in the pocket place a card of assorted silk ligature1 ranging in size from one to six1 half a dozen egg-eyed needles ranging from full to half curve1 one yard of oiled silk or an equal amount of gutta-percha tissue1 one bottle bichloride of mercury tablets mentioned before1 half ounce ,squibb's surgical powder in shaker-top can1 four ounces absorbent cotton in carton1 two yards sterilized cotton gauze sealed1 a paper of safety pins and another of common pins1 one soft rubber catheter1 number #i1 one roll adhesive tape two inches wide4 ,in the loops place one needle-holder 7,emmet's71 one hypodermic syringe 7all metal71 one pair straight shears about six inches1 two hemostatic forceps 7,kelly's71 one curved bistoury 7small71 and one splinter forcep4 ,the metal case for the hypodermic has compartments for small tubes containing the hypodermic tablets4 ,take one tube each of the following3 hydrochlorate cocaine gr4 #a_/d1 morphine sulphate gr4 #a_/d1 strychnine sulphate gr4 #a_/fj4 ,with the foregoing rather limited equipment you will be able to render assistance to a person injured in any of the accidents likely to occur in the woods4 ,there are a few surgical principles that should be impressed upon your mind before the subject of treatment is taken up4 ,the first and most important of these is that it requires a great deal more loss of blood than is popularly supposed to endanger life4 ,there is no danger from hemorrhage from a vein and but little from any of the smaller arteries4 ,the free flow of blood from a wound instead of being alarming is the most beneficial thing that can happen4 ,the cleansing power of flowing blood cannot be overestimated and it is cleansing that all wounds require4 ,that brings up a second thought4 ,all serious consequences arising from incised or punctured wounds come from the invasion of bacteria1 and all your efforts should be directed against these energetic little gentlemen1 either those that have already entered the wound or those that are striving to gain ingress4 ,a simple cut will1 if permitted to seal itself up in its own blood1 generally heal without any further interference4 ,the man who puts tobacco1 flour1 soap1 or any other of the popular monstrosities on a wound is little short of a criminal4 ,while1 theoretically1 many people know that blood flowing in a steady stream is coming from a vein and that flowing in jets or spurts is coming from an artery1 few know how to take advantage of that knowledge4 ,the general rule to make pressure between the heart and the wound in case of a jet and between the wound and the extremity in case of a stream is only good as a general rule2 there are exceptions and it is exceptions that make the rule dangerous4 ,there are times when it becomes necessary to reverse the process4 ,the proper way is to make compression with your fingers until you have located the region the blood comes from2 then apply your steady compression in that locality4 ,there are a few great arterial trunks that lie near the surface and may become injured1 the injury causing death from hemorrhage4 ,the manner of locating the compression point for these arteries will be given4 ,the first of these is the great artery that runs down the inside of the leg1 called the femoral4 ,bleeding from this vessel will result in death in a very few minutes1 and it has been known to be severed by a man falling on his sheath knife4 ,the bleeding may be controlled by grasping the leg with the fingers near the body4 ,about half way down the inner surface of the leg the fingers will fall into a slight depression1 at the bottom of which lies the femoral artery4 ,any of the vessels of the lower limb may be controlled by compressing just behind the knee between the two prominent tendons that will be found there when the leg is doubled up4 ,arteries of the forearm and hand can be stopped by pressing with the thumb at the elbow joint just to the inner side of the tendon of the biceps which you may feel like a cord when the arm is extended4 ,if the bleeding is from the upper arm stretch the whole arm by raising it above the head4 ,feel in the armpit and you will locate a prominent ridge on the inner side2 press with your fingers just behind that ridge and you will shut off the blood supply from the whole arm4 ,these are the more prominent vessels that lie near the skin4 ,certain of these larger arteries require ligation4 ,the ligation of an artery calls for a certain amount of surgical skill1 but if it is necessary to save life you can do it4 ,surgeons now use sterilized catgut for the purpose1 but silk can be used as well1 taking care to leave sufficient end hanging out of the wound to remove it by4 ,after having made compression and controlled the hemorrhage1 clean out the wound and loosen your tourniquet until the blood spurts4 ,locating the artery1 grasp it in the bite of the hemostatic forceps4 ,cut off a short piece of silk and tie it loosely around the forceps4 ,have some one pull up on the forceps and at the same time with your forefingers slip the knot down over the end of the cut vessel4 ,tie tight and remove your forceps4 ,this procedure will be necessary only in case of injury to large vessels4 ,smaller arteries can be controlled by the means hereafter described1 or by placing a heavy pad of gauze over them and making compression with a tight bandage4 ,the blood will become entangled in the meshes of the cloth and form a clot4 ,incised wounds inflicted with sharp instruments will be found to comprise practically all the injuries occurring in the woods4 ,the method of treating one will illustrate that of dealing with all4 ,let us suppose that in cutting firewood the camper has had the misfortune to drive a sharp ax into his instep 7a quite common accident74 ,the blood spouts at once in a very alarming manner4 ,he hobbles to the camp and removes his shoes4 ,an ugly gaping wound appears1 from the bottom of which blood is jetting1 indicating that an artery has been severed4 ,the first thing necessary is to stop the blood4 ,take a handkerchief or other cloth and tie it about the ankle rather loosely1 place a small stick or a table fork beneath it and twist4 ,in a few turns you will note that the blood is flowing with less force and shortly will cease altogether4 ,when the bleeding has been entirely controlled get out your surgical kit and throw a pair of the hemostatic forceps into the boiling water4 ,after they are sterilized wash the wound free from blood with pure water4 ,i will add in this connection that spring water in the mountains is practically sterile and can be used for washing wounds without any danger of infection4 ,after the wound is clean have some one slightly loosen the tourniquet4 ,as he does this watch sharply for the jet of blood that will locate the cut artery4 ,as soon as you see it grasp it with the forceps1 lock them1 and leave them in place4 ,the compression of the forceps while you are getting ready your other instruments will seal up the vessel so that when you remove them it will not bleed any more4 ,take two of your full curved needles1 at least two inches long1 and thread them with quite coarse silk1 cut off a piece of your gauze and run the needles through it4 ,place the needles thus prepared1 the needle holder1 shears1 and the other pair of hemostats in a vessel and boil4 ,in the meantime make up a solution of the bichloride1 using the antiseptic tablets for that purpose4 ,wash your hands well and rinse them in the bichloride solution4 ,clean out the wound1 taking great care to remove all clots4 ,with one of the threaded needles in the grasp of the needle holder begin at the upper angle of the wound1 about half an inch from the end4 ,pass the needle down through the flesh one-fourth of an inch from the edge1 carrying it well toward the bottom and making it enter the wound near the bottom and re-enter the flesh on the opposite side1 pass up through and out an equal distance from the edge4 ,cut the thread off and lay the two ends out of your way1 leaving1 of course1 sufficient to tie with when the time comes4 ,place your row of stitches half an inch apart all down the wound4 ,when all the stitches are in place you may begin to tie4 ,take the two ends of the first stitch in your hands and lift up on them2 this will bring the edges of the wound together4 ,tie the thread1 turning the first knot under twice to prevent its slipping4 ,after all the stitches have been tied take the handle of your scalpel or the forceps and raise the edges of the skin1 which will have rolled in1 until they meet each other4 ,this is necessary1 as where the skin is rolled in it will not heal readily and leaves an opening for the entrance of bacteria4 ,sponge off all the free blood and dust well with surgical powder4 ,place a pad of gauze that has been soaked in the bichloride solution over the wound1 cover that with a wad of cotton and the cotton with a piece of oiled silk1 bandage over all1 and do not molest for at least three days4 ,after five days you may remove your stitches in this manner3 ,cut the stitch near the skin on one side1 grasp the knot in the bite of the forceps and pull it out4 ,be careful not to try to pull the knot through the flesh1 and do not leave any end on the part you do pull through the flesh1 as it may carry infection down into the wound4 ,it is a fact not generally known to the laity that a solution of common salt and water will take the place of blood when introduced into the system4 ,surgeons resort to this practice in performing all very bloody operations4 ,their method of hypodermoclysis could not be carried out in the camp1 of course1 but a very good substitute for it can be used4 ,the lower bowel is very receptive of this solution1 which by the way1 is made by dissolving a teaspoonful of clean common salt in a pint of water4 ,the solution1 maintained at blood heat1 is introduced into the lower bowel with a fountain syringe4 ,persons who have lost a great deal of blood1 so much in fact that their pulse can hardly be felt at the wrist1 will receive great benefit from this procedure4 ,use at least a gallon of the solution and do not permit it to flow too rapidly into the bowel4 ,certain cuts may be dressed without stitches4 ,proceed as before up to the point of putting in the stitches1 then roll up two pieces of gauze as long as the cut and about the size of a lead pencil4 ,lay these on either side of the wound quite close to it4 ,with adhesive tape half an inch wide and four inches long begin two inches on either side of the wound and carry across1 bringing the edges of the wound together4 ,place these strips half an inch apart until the wound is brought into line4 ,dress as before1 except that you will have to omit the moist gauze1 dressing with the powder entirely4 ,i want to add here that should you run out of sterilized gauze at any time you can make it from any soft cloth by boiling it for ten minutes in the bichloride solution and hanging in the air to dry4 ,the pain attendant upon any surgical manipulation can be prevented by the hypodermic injection of a solution of cocaine4 ,when you get your hypodermic have the instrument man show you how it works4 ,he can show you much better than ,i can tell it4 ,insert the needle half an inch from the wound and inject a few drops of the solution into the skin4 ,proceed thus entirely around the wound and by the time you are through the wound will be perfectly painless4 ,before replacing the instrument in its case always dry it out and replace the small brass wire that you will find in the needle4 ,it is somewhat difficult to approach the subject of punctured wounds1 which also include those resulting from gun shots and powder explosions4 ,the rule among surgeons is to meddle with these injuries as little as possible1 provided they do not penetrate the abdomen4 ,in the case of penetrating wounds caused by falling on a sharp stick or other sharp pointed instrument1 it is well to clean out the wound1 removing all foreign substance that may be present1 searching diligently for pieces of cloth1 rust1 charcoal1 bark1 or other foreign matter4 ,these things in certain localities contain the germ of lock-jaw1 and many contain it anywhere4 ,this is particularly true of felt wads from shotgun shells4 ,all diligence should be exercised to clean out a wound resulting from such a cause4 ,shotgun wads are manufactured from the most filthy kinds of old hair1 often reeking with the bacillus of tetanus4 ,if the wound was caused by a sliver of wood and the sliver still remains in the wound remove it by making an incision with your bistoury4 ,do not be afraid to cut4 ,a little cut is worse than none2 go deep enough to liberate the sliver so that it may be removed with the splinter forceps4 ,then wash the wound from the bottom with hot water and dress as before1 using the bichloride4 ,experience has proved that the less one attempts to do with gunshot wounds the better4 ,nature has a tendency to wall off foreign bodies that are in the main sterile and will ordinarily do so with a bullet if given a chance4 ,keep the patient quiet1 prevent infection from entering the wound1 and trust to ,nature to do the rest4 ,an incident will illustrate what takes place when ,nature is given an opportunity to throw out her plastic wall material around a foreign body4 ,some years ago a party of ,eastern people were camping in the heart of the ,bitter ,roots4 ,among the party were two boys of the age when boys are prone to try experiments4 ,they bored a small hole in a spruce tree and drove into it a high power #cj-cj cartridge4 ,then they stood off some fifteen feet and fired at the cartridge with a small rifle4 ,one of them hit it4 ,the #cj-cj shell came back and penetrated the abdomen of the juvenile marksman1 burying itself and driving pieces of clothing into the abdominal cavity4 ,the messenger who came for me was thirty-six hours on the trail and ,i was an equal length of time reaching the camp4 ,the people had had sense enough to keep the patient quiet and ,i found him resting fairly easy4 ,so deeply had the missile penetrated that it required a considerable incision to remove it4 ,when ,i reached the bottom of the wound ,i found that ,nature had thrown about the wounded area a wall of protective lymph and all the pus that had accumulated was in a pocket4 ,i laid the pocket well open1 evacuated its contents1 and removed the bits of cloth that ,i found1 dressed the wound1 and had the satisfaction of seeing the youngster recover4 ,burns are classified according to degree of injury4 ,those of the first degree are where the skin is reddened1 but no blister formed4 ,the second degree includes those where there has been decided blistering1 and the third1 where the flesh has been charred4 ,those of the first and second degrees are the most common in about the proportion of #ii to #a4 ,a burn of the first degree can be best relieved by the application of cold water4 ,this is contrary to the teachings of a few years ago1 but is in full accord with that of to-day4 ,the water should be changed as fast as it becomes warm4 ,burns of the second degree require more care4 ,in the first place1 do not interfere with the blister4 ,the primary object in treating burns is to exclude air and the skin remaining intact will do this much better than any artificial means4 ,the ,indians of the ,northwest prepare a dressing for burns by cooking deer suet with balm of gilead buds4 ,this is the most effective application for severe burns ,i have ever seen4 ,if deer suet is not available1 any fresh tallow that has been cooked will serve as well4 ,throw a handful of the buds into a vessel and cover them with the suet1 boil for thirty minutes1 and strain4 ,when nearly cold apply to the burn and cover with a soft cloth4 ,the pain ceases almost immediately4 ,it seems singular after all that has been written on the subject1 but few people know how to restore a drowned person4 ,the matter is really quite simple1 yet it requires great attention to detail4 ,spasmodic efforts are useless4 ,the thing has to be gone about methodically and the method persisted in for a long time1 often in the face of seeming certain defeat4 ,in the first place1 statistics show that no person who has been submerged in the water for a period of seven minutes was ever resuscitated4 ,it is extremely doubtful if after five minutes' immersion anything can be accomplished1 still it is worth the effort4 ,the first thing to do when a person is rescued from the water is to remove all clothing from about the chest and neck4 ,do not take the time to draw the garments off1 but rip them off with a knife4 ,turn the body over and stand astride it4 ,grasp it about the middle and lift up so that only the head and feet are touching the ground4 ,this is done in order to free the lungs and air passages from water and mucus4 ,do this several times4 ,with a handkerchief wipe out the mouth and as far down the throat as you can reach4 ,lay the patient on his back with a folded coat under his shoulders4 ,kneel at his head and grasp both arms at the wrists and pull them well up over his head1 hold for an instant1 return to the sides and press them against the ribs1 hold for an instant and repeat4 ,do this about twenty times each minute4 ,the tendency is to work too fast4 ,the movement should be about as fast as a man breathes1 the object being to simulate the ordinary respiratory movements as nearly as may be4 ,while this is being done another person may grasp the tongue and pull it up and out of the mouth1 keeping time with the movements of the arms4 ,when the patient begins to show signs of life wrap him well in hot blankets1 place hot stones at his feet1 and administer hot water1 brandy1 or strong hot coffee4 ,as before suggested1 the efforts at restoration should be persisted in for a long time1 until either success rewards your efforts or the body becomes quite cold and rigid4 ,it may be that there is a little spark of life left and you may fan it into flame after hours of effort4 ,there are many minor accidents for which it is well to be prepared4 ,for example1 to remove a fish hook3 ,do not try to pull it back2 push it on through1 file or break off the barb and it can be removed readily4 ,to remove foreign bodies from the eye3 ,first cocainize the eye by dropping a few drops of a solution made by dissolving one of the cocaine tablets in a half teaspoonful of water1 then turn the lid back over a match telling the person to look down at the same time1 and brush the substance off with a soft cloth4 ,if it is under the lower lid place your forefinger on his cheek just beneath the eye1 pull down1 and tell him to look up4 ,if it adheres to the eyeball1 as in the case of a cinder or a small piece of steel1 after cocainizing the eye remove with a sharp knife by brushing4 ,insects sometimes crawl into the ear and make a lot of commotion4 ,place the patient on his side with that ear uppermost and pour plenty of warm water into the ear4 ,by plenty ,i mean several quarts4 ,the bug will crawl out or be washed out by the returning stream of water4 ,burns well characterized toothache as ,thou hell of a' diseases4 ,if the tooth has a cavity 7as it probably has71 a small crystal of cocaine dropped dry into the cavity and covered with a little pledget of cotton will give immediate relief4 ,for bleeding from the nose1 place a pledget of cotton in each nostril1 lay the patient on his face1 and pour cold water over the back of the neck4 ,leave the cotton there for several hours4 ,the idea is that the fibrin in the blood becomes entangled in the fiber of the cotton and sets up a clot that seals the bleeding surface1 while the cold water closes the blood supply by its action on the artery supplying the parts4 ,hiccough is a distressing and sometimes a dangerous complaint4 ,many times a swallow of water will stop it4 ,if simple measures fail1 the following has been found very efficacious4 ,the nerves that produce hiccough are near the surface in the neck4 ,they may be reached and compressed by placing two fingers right in the center of the top of the breastbone between the two cords that run up either side of the neck and pressing inward1 downward1 and outward4 ,a few minutes' pressure of this kind will stop the most obstinate hiccough4 ,certain injuries are attended with what is known as shock4 ,usually the degree of shock is proportionate to the extent of the injury1 though not always so4 ,often seemingly trivial injuries produce a fatal shock4 ,the symptoms are cold1 clammy skin1 face very pale and pinched1 eyes widely dilated and staring1 pulse rapid and irregular1 little or no pain1 even from severe injuries4 ,the patient retains his mental faculties but loses the power to originate1 answering when spoken to but usually volunteering no statements of his own4 ,the treatment consists in lowering the head and elevating the extremities4 ,wrap the patient in hot blankets and place hot water bottles about him1 give brandy1 or what is as good1 hot water2 inject #a_/cj gr4 strychnia every fifteen minutes for three doses4 ,the symptoms from loss of blood are very much the same as from shock and luckily respond to the same treatment4 ,in addition1 if there chances to be a fountain syringe in the camp1 give rectal enemas of hot normal salt solution1 which can be made by dissolving a teaspoonful of common salt in a quart of sterile water4 ,in some way this solution seems to take the place of the blood lost4 ,a hot application over the heart is also valuable1 as are mustard drafts to the spine4 ,,medical ,,treatment ,,of ,,camp ,,diseases ,,chapter ,,iii ,,medical ,,treatment ,,of ,,camp ,,diseases ,in this day of compact pharmaceuticals one can carry a complete equipment of medicines in a vest pocket almost4 ,the old day of ponderous powders and nauseating liquids has passed4 ,the physician now who prescribes for his patients immense bottles of shotgun mixtures writes himself down a back number4 ,this manner of administering drugs can be taken advantage of by the man who wishes to carry with him upon his outing a supply of remedies for the relief of such ailments as may befall him4 ,oliver ,wendell ,holmes once said in delivering an address to the graduating medical class of ,harvard1 ,young men1 you have been taught here at least twenty remedies for every disease2 after you have practiced medicine twenty years you will have one remedy for twenty diseases4 ,the genial autocrat was nearly right4 ,the longer one continues in the practice of medicine1 the fewer remedies he learns to depend upon4 ,an ,irish medical friend of mine once put the thing in very apt form when he said1 ,if ,i had to practice medicine on an island where ,i could have only three remedies1 ,i should choose castor oil1 opium1 and strychnia4 ,i'd physic them with the castor oil1 constipate them with the opium1 and stimulate them with the strychnia4 ,these remarks are a little beside the subject1 but ,i am constrained to quote them to illustrate that but few medicines are needed1 if these be well understood1 and the indications for their use can be mastered by anyone in a short time4 ,for the past several years my emergency medical case has contained only ten remedies1 and with these ,i have not hesitated to make professional trips of many miles4 ,the case should be made of sole leather with a pocket for a small note book and loops for a clinical thermometer4 ,the bottles should hold half an ounce and have screw caps4 ,have the glazier etch with his diamond the numbers from #a to #aj on the sides of the bottles4 ,the reason for this is that numbers pasted on are liable to rub off1 and as many tablets look much alike confusion may occur4 ,then fill them in this manner3 ,no4 #a3 ,calomel1 gr4 #a_/d4 ,make this entry in the little note book that is contained in the pocket4 ,no4 #a1 calomel gr4 #a_/d4 ,dose1 one tablet every thirty minutes for four hours4 ,indications1 biliousness1 headache from disordered stomach1 diarrhea1 colds1 and the beginning of all fevers4 ,no4 #b3 ,dosimetric trinity 7,full strength74 ,dose1 one granule every half hour until skin becomes moist4 ,indications1 all fevers1 colds1 threatened pneumonia1 and threatened typhoid4 ,no4 #c3 ,chlorodyne4 ,dose1 one tablet every hour to relief4 ,indications1 any gastric pain1 cramps1 diarrhea 7after cleaning out the bowels71 colic1 acute indigestion4 ,no4 #d3 ,intestinal antiseptic4 ,dose1 one tablet every hour for four hours2 then one every three hours4 ,indications1 after bowels have been cleaned out to correct any disorder of the tract1 as a routine treatment of typhoid2 always valuable in diarrhea and other inflammatory conditions of the bowels4 ,no4 #e3 ,quinine sulphate1 gr4 #e4 ,dose1 one tablet every four hours4 ,indications1 colds and catarrh1 bilious fevers1 specific in malaria4 ,no4 #f3 ,elaterin1 gr4 #a_/af4 ,dose1 one tablet4 ,indications1 to remove all fermenting food matters in the stomach and bowels1 produces excessive watery evacuations4 ,valuable in dropsy2 especially applicable where you want to get rid of the entire contents of the bowels4 ,no4 #g3 ,phenacetine1 gr4 #e4 ,dose1 one tablet every three hours to profuse perspiration4 ,indications1 reduce fever where pulse is full and bounding4 ,relieves headache2 taken early cures severe cold4 ,no4 #h3 ,sun ,cholera4 ,dose1 one every three hours4 ,indications1 similar to ,no4 #c1 only more powerful1 valuable in severe summer complaint due to eating fresh fruit1 meat1 drinking too much water4 ,relieves gastric pain4 ,no4 #i3 ,apomorphia hydrochlorate1 gr4 #a_/aj4 ,dose1 two tablets followed by swallow of hot water4 ,indications1 as an emetic in poisoning4 ,use cautiously4 ,no4 #aj3 ,digitalin1 gr4 #a_/ajj4 ,dose1 one tablet every hour to effect4 ,indications1 the most powerful heart tonic and reconstructive4 ,must be used cautiously4 ,valuable in loss of blood1 excessive heart action from altitude1 and all conditions where heart is not performing properly4 ,it will be noted that ,i did not mention morphine1 strychnia1 or cocaine1 as they were spoken of in connection with the hypodermic4 ,in the case ,i also place a one-minute clinical thermometer4 ,all of these instruments are now made self-registering and must be shaken down after each using4 ,this should be done1 not by a jar1 but with a long sweep of the arm4 ,too sudden a jar will snap the instrument in two4 ,shake until the mercury column stands below the mark4 ,this mark indicates the body heat at normal condition1 that is1 #ih4d ,f4 ,every man should familiarize himself with certain physiological facts1 and with these as guideposts he ought to be able to follow a train of indications to a reasonably fair diagnosis4 ,the pulse rate1 taken at the wrist1 is generally a fair index of the condition of the body4 ,the normal man has a pulse rate of about seventy-two beats per minute1 women somewhat more rapid2 high elevations also produce a more rapid pulse4 ,if there is an increase of heart beat above eighty per minute1 accompanied by other subjective symptoms1 it is an indication that something is wrong4 ,in the absence of a clinical thermometer1 one can arrive at a pretty fair knowledge of the body heat by counting the pulse4 ,it is estimated that there will be an elevation of one degree ,f4 for every ten beats above the normal4 ,this rule varies1 but is a fair average4 ,the appearance of the tongue is a valuable signpost1 but one that is difficult of mastery4 ,a few prominent indications will be noted4 ,a thin1 white1 even furring of the tongue is indicative of gastric disturbances and mild fever states4 ,a flabby1 swollen1 indented tongue covered with a uniform yellow1 pasty fur is indicative of profound gastric states and gastro-duodenitis2 it may also be produced by a continued moderate fever4 ,a narrow tongue1 with deep median fissure on each side of which is a thick rough fur1 the tip and edges being red and denuded1 is characteristic of typhoid states whether arising from typhoid or not4 ,the same condition will be found in profound intoxication from septic poisons4 ,if the tongue becomes dry and brown1 tremulous when protruded1 and the patient returns it slowly when requested to do so1 he has typhoid beyond question4 ,a brown fur on the root of the tongue1 especially in the morning1 indicates a sluggish condition of the liver4 ,in jaundice the tongue is yellow4 ,it is estimated that the normal man in a state of rest will breathe sixteen times per minute4 ,any radical departure from the rate will indicate disease4 ,an increase of two respirations per minute is supposed to indicate a rise of one degree ,f4 in the body temperature1 though this rule is subject to variations4 ,inspection of the bare chest tells the trained physician much regarding the condition of his patient and even the layman can glean much knowledge from that source4 ,if the patient is breathing from twenty-five to thirty-five times per minute1 the respiration being confined to one lung as indicated by the lack of expansion in the other1 and if he lies so as to take the strain off the lung that does not expand1 it is almost sure that the patient has pneumonia4 ,in case the lung is fixed rigidly by the muscles and the opposite lung forced to do all the work1 then the patient has pleurisy4 ,in profound typhoid states the breathing is very much slowed and irregular1 at last presenting what is known as the ,cheyne-,stokes respiration1 in which the patient will breathe several short shallow respirations1 pause for a time1 heave a deep sigh and then repeat the rapid breathing4 ,this type of breathing is looked upon as a very grave symptom in all conditions characterized by lack of physical strength4 ,it will be readily appreciated that only enough discussion of symptoms has been given above to aid somewhat in arriving at a diagnosis4 ,to go deeply into physical indications of diseases would be manifestly out of place in an article of this character4 ,we will now proceed to the consideration of the diseases that will be most frequently encountered in the camp4 ,of these the intestinal troubles stand pre-eminent4 ,change of water1 food1 methods of life1 and personal habits account for the fact that nearly every person who seeks the outdoors at some time during his stay is afflicted with some one of the diarrheas4 ,without attempting to go deeply into the various classifications of the enteric complaints1 a brief rsum of the guiding symptoms common to all will be given4 ,it matters very little so far as the treatment is concerned whether it be an ileo-colitis1 an ileitis1 or simply colitis4 ,the same treatment would obtain in each case1 and the same general trend of symptoms would be present4 ,the patient feels a general indisposition1 loss of appetite1 headache1 and sleeplessness1 which is followed by pain and griping in the bowels2 then comes the diarrhea1 which may be profuse and watery or scanty and accompanied by much pain4 ,the evacuations become exceedingly frequent1 sometimes as many as fifty or sixty per day4 ,the patient vomits frequently and is quite ill1 his face becomes pinched and dusky1 with an anxious look in the eyes4 ,there is some fever and thirst1 though the water drunk is generally vomited4 ,in the above has been pictured an extreme case of summer diarrhea4 ,there will be all gradations below this1 from a mere soreness of the abdomen and looseness of the bowels up to profound prostration from constant drain on the system induced by the evacuations4 ,by a sort of strange medical paradox1 in order to stop the evacuations it becomes necessary to increase them4 ,we must sweep out the nest of troublesome bacteria that are causing the disturbance4 ,an ordinary cathartic will not accomplish this4 ,it is necessary to administer something that will produce a profuse watery discharge from the bowels4 ,nothing accomplishes this better than a heaping tablespoonful of ,epsom salts in hot water1 but as we have not provided for such bulky medicines in our case we will give our patient one tablet of elaterin which will accomplish the same purpose4 ,then1 too1 the patient is not nearly so liable to vomit the elaterin4 ,if he does1 however1 the vomiting can be controlled by the administration of cocaine by the mouth1 though this latter drug must be used very cautiously4 ,a tablet of #a_/d gr4 cocaine hydrochlorate given in a swallow of hot water will stop vomiting until the other remedies can produce their effect4 ,before giving any other medicines await the free action of the cathartic4 ,the patient should have at least three very copious discharges2 then begin to combat the inflammatory condition that exists in the bowels4 ,the chlorodyne tablet will in all ordinary cases1 do this best of all your remedies4 ,there will be some few instances where it will be necessary to resort to more powerful remedies2 in that case the ,sun ,cholera tablet given according to directions is the best4 ,as an after treatment in these cases the intestinal antiseptic gives the best results4 ,a tablet every four hours for two days will annihilate every vestige of bacterial invasion that may remain4 ,bronchial and pulmonary diseases supply a large percentage of the camp ailments in the fall and early winter during the deer hunting season4 ,an attack of pneumonia following a severe drenching from being out all day in a rain1 or accidentally tumbling into the creek1 is not a pleasant thing to contemplate4 ,it usually comes in the night4 ,the patient wakes out of a sound sleep with a chill4 ,there is a sharp sticking pain as though a knife were being thrust between the ribs1 at some point on the chest wall4 ,the breath comes in short gasps and the patient instinctively turns toward the affected side in order to ease the pain4 ,the chill may or may not be followed by vomiting1 and the fever lights up immediately1 rising to #ajb-d ,f4 ,a distressing short cough comes along to add to the discomfort as each act of coughing increases the pain in the chest4 ,in less than twenty-four hours the patient begins to expectorate what we call prune-juice mucus1 that is1 mucus streaked with blood until it resembles the juice of cooked prunes4 ,when you see this prune-juice you need have no doubt as to the diagnosis4 ,you should1 however1 have been busy long before this4 ,there is no doubt now among educated physicians that pneumonia1 taken in time1 can be aborted4 ,when the pain first manifests itself set somebody to baking hot cakes made from flour stirred with water4 ,while these are still as hot as can be borne lay them over the painful spot on the lung1 renewing as fast as they become cool4 ,to accomplish much good this treatment must be kept up until the period of expectoration and even after1 at least twenty-four hours4 ,at the same time begin by administering calomel in #a_/d gr4 doses every thirty minutes until at least three grains have been given4 ,two hours after the last tablet of calomel has been given1 give a tablet of elaterin4 ,when the latter has worked1 start in with the dosimetric trinity tablets and push them until the skin becomes moist and the fever falls below #ajj ,f4 ,do not give any of the coal tar products in pneumonia1 that is1 do not give phenacetine or acetanilide4 ,when the patient is recovering it is well to keep up the heart by strychnia or digitalin4 ,there is such a thing as giving too much of these heart stimulants though1 and you should watch the pulse closely4 ,stimulating the heart too greatly is liable to cause congestion of the small blood vessels in the lungs and defeat the very purpose you set out to accomplish4 ,taking cold is a very popular camp method of feeling bad4 ,the man who does not at least once1 while in camp1 stuff himself full of a good old-fashioned cold feels that he has been cheated out of a part of the enjoyment of his outing4 ,for the benefit of those of his companions who do not appreciate his barking in season and out1 the following rules are suggested3 ,first1 take a bath2 it may be painful but necessary4 ,second1 assist overworked eliminants to remove the debris that has accumulated by reason of the failure of the ordinary processes of waste removal4 ,this can be done very nicely with a heroic dose of calomel2 by heroic about three grains is meant4 ,follow up the calomel with several five-grain doses of phenacetine1 or until the patient is in a profuse perspiration1 roll him in warm blankets1 and await developments4 ,a careful observance of the foregoing will annihilate any able-bodied cold on earth4 ,the man who contracts rheumatism in camp has my sincere sympathy4 ,it requires no special skill to tell when one has it1 but it does require special powers of divination to tell when he will get rid of it4 ,medical science has discovered only one drug that will affect the progress of the disease in the least1 and that only after an extended course4 ,salicylic acid in one or another of its various combinations furnishes the sheet anchor in the treatment of rheumatism4 ,i purposely omitted it from our pocket case of drugs because of the fact that the combination that would suit one man's stomach would not another4 ,in practice we have to take many things into consideration in the administration of the salicylates4 ,the man with rheumatism in camp can seek only to relieve the pain and assist ,nature to eliminate the waste4 ,a thorough flushing of the bowels should be the first thing1 followed by aconitine1 gr4 #a_/acd1 one tablet every hour for four hours2 then one every three hours4 ,at the same time keep dry4 ,if it be a limb that is affected wrap it in blankets and cook it in front of the fire4 ,cases of poisoning arising in camp will usually be confined to two causes--the eating of poisoned foods and eating poisonous mushrooms4 ,in these days of tinned meats and vegetables it is not unusual to hear of persons becoming seriously and even fatally poisoned by eating certain canned goods4 ,canned fish and beef are the worst offenders in this regard4 ,the symptoms of ptomaine poisoning are characteristic and generally easily traced to the material producing them4 ,there is a dryness and metallic taste in the mouth shortly after eating suspected food4 ,this is followed by severe cramps1 vomiting1 violent purging1 rapid loss of strength1 great depression and coldness of the surface of the body4 ,the hands and face break out in clammy sweat and the temperature falls below normal4 ,the picture is very characteristic and when once seen is readily recognized4 ,the treatment consists in getting rid of the offending substance as quickly as possible4 ,nothing accomplishes this more readily than a quick emetic4 ,apomorphia hydrochlorate furnishes us with the most convenient emetic1 though mustard water or hot salt water will do4 ,take a tablet of #a_/aj gr4 apomorphia hypodermically1 or two tablets of the same size by the mouth1 followed by a swallow of hot water4 ,hypodermically the emetic acts in a very short time2 by the mouth it requires somewhat longer1 say ten minutes4 ,purge the bowels with elaterin1 one tablet1 then keep up the vital forces by administering strychnia1 #a_/fj gr4 every hour or two1 watching the circulation meanwhile4 ,in severe cases1 in addition to the strychnia1 it may become necessary to resort to external heat1 hot water bottles1 hot stones1 etc4 ,the patient is much debilitated for several days and requires careful diet4 ,mushrooms should never be eaten unless the person gathering them is known to be thoroughly conversant with the different varieties4 ,certain poisonous varieties resemble the edible so closely that only an expert can tell the difference4 ,the knowledge1 however1 is one that every hunter and camper should familiarize himself with as mushrooms are usually plenty in the hills and furnish an agreeable addition to the menu4 ,phalline1 the toxic principle of the phalloid group of mushrooms1 is a toxalbumin of extreme violence and resembles very much the toxic albuminose of rattlesnake virus2 in fact1 it seems to act upon the digestion very much as crotalin does upon the circulation4 ,there is another toxic principle present in certain other varieties of fungi called muscarine2 both these poisons act very similarly4 ,the symptoms are a feeling of giddiness coming on from one hour to fifteen hours after eating the fungus4 ,this is followed by profuse salivation1 the water running out of the patient's mouth in a stream4 ,blindness ensues1 and vomiting and diarrhea come in their train4 ,the heart is weakened and the patient breathes with difficulty4 ,at the last he lies in a stupor4 ,the treatment is similar to that of ptomaine poisoning4 ,remove the offending material at once by the same process4 ,for a purgative oleaginous agents are the best if available1 castor oil being preferable2 failing in that any active cathartic will do4 ,the heart then must be stimulated by the digitalin2 strychnia also plays a prominent role here4 ,it had not been my intention to mention typhoid1 but upon reflection ,i have decided to include it4 ,typhoid fever is little liable to attack people living under such conditions as exist in the mountains where the air is pure1 the water comes from eternal springs1 and flies are few4 ,summer camps along lake shores and the larger1 slow-moving streams are liable to it1 and it is just as well to recognize it when it arrives4 ,the person about to come down with typhoid generally feels extremely tired for several days1 the head and back ache1 the nose frequently bleeds slightly1 a rumbling is present in the right side just below the ribs1 and the ears rings as though one had taken an overdose of quinine4 ,the tongue is characteristic of the disease1 so much so1 in fact1 that we speak of a particular condition as the typhoid tongue4 ,after a few days the patient begins to feel feverish4 ,all the symptoms increase until he is quite ill and takes to his bed4 ,about this time tiny red spots called rose spots appear on the abdomen1 perhaps only a few1 again they are quite frequent4 ,the mind becomes dull and the hearing imperfect4 ,typhoid is said to be a self-limiting disease1 that is1 it cannot be cut short or aborted in any way4 ,that1 however1 is hardly the case4 ,by vigorous treatment1 at the outset1 it is now thought by a great many that the disease can be limited to a few days4 ,if the treatment is not begun early and carried out1 the disease will run a course of some twenty-one days4 ,the treatment consists in eradicating the nest of typhoid bacillus that is setting up the disturbance4 ,here1 again1 we resort to calomel4 ,four grains given in quarter-grain doses every half hour will usually produce sufficiently free passages4 ,after this administer the intestinal antiseptic religiously1 with aconitine for the fever4 ,give plenty of water to drink and restrict the diet4 ,if the disease gets beyond control1 the routine treatment is the intestinal antiseptic4 ,cold packs for the fever1 in the later stages of the disease1 will be found preferable to any medicines4 ,all the time the diet should be watched4 ,no solid foods should be allowed4 ,milk1 light broths1 fruit juices1 and rice water supply sufficient nourishment and do not irritate the tender glands of ,peyer and ,brunner that are the seat of the disease4 ,these glands become very friable in typhoid1 and any violent action of the walls of the intestines1 as in digesting food1 will cause them to break through and permit the bowel contents to enter the general peritoneal cavity1 when the patient will die from inflammation of the bowels4 ,,serpent ,,wounds ,,and ,,their ,,treatment ,,chapter ,,iv ,,serpent ,,wounds ,,and ,,their ,,treatment ,every summer outdoor ,america leaves the heat and dust and turmoil of the city for the peace and quiet of the wild4 ,doubtless many persons penetrate1 in their outing1 regions where venomous serpents abound4 ,these will carry as a part of their equipment remedies intended for the relief of wounds inflicted by these4 ,many of these remedies will be absolutely valueless for the purpose intended1 and many more will fail from lack of intelligent application4 ,a brief discussion of serpents and the approved methods of treating their wounds may prove of interest at this time4 ,permit me to state at the outset that such information as may be contained in this chapter is not the result of conjecture and guesswork1 but is derived from over twenty-five years study of reptilian zology1 many years investigation in the laboratory1 during which time an extended series of experiments were carried out1 and twelve years' actual practice1 in which all of the methods that have suggested from time to time have been thoroughly tested4 ,there are1 roughly speaking1 something like twenty-eight varieties of venomous reptiles in the ,united ,states4 ,these figures include the one lizard that is known to be poisonous and the several scorpions4 ,of this number the rattlesnakes comprise at least eighteen4 ,in fact1 so important are they that all others may be included in a discussion of the crotalid2 more particularly so as all serpent venoms act chemically in the same manner4 ,man is unreasoningly afraid of snakes4 ,it is rare1 indeed1 that a person concerns himself with the classification of the serpent that chances to cross his path4 ,he immediately possesses himself of a stout club and proceeds to maul the unoffending reptile into the earth without troubling his mind to find out if the snake is harmless or otherwise4 ,this is wrong1 for when one comes to know them serpents are quite interesting4 ,it is wrong1 too1 for with a little study the ordinary man can familiarize himself with the characteristic markings of the venomous serpents and differentiate them from those that are non-venomous4 ,all the deadly snakes1 with the exception of the little harlequin snake of the extreme ,south1 are similarly marked and all belong to the class of pit vipers1 characterized by a depression or pit back of the nostril4 ,the head is triangular1 with massive muscular development of the jaw2 the neck slender in proportion to the size of the head and body4 ,the body itself is quite thick1 the skin rough4 ,the pupil of the eye is elliptical instead of being round as in the non-venomous snakes4 ,the harmless varieties1 on the other hand1 are long and slender1 the skin smooth and shining1 the head oval or round4 ,if in doubt after the above1 the investigator can pin his subject to the ground with a forked stick placed just back of the head and examine the teeth4 ,if he finds1 hanging from the upper jaw1 or inclined forward from it1 two fangs1 long and sharp as needles1 he can be pretty safe in assuming that his subject is poisonous4 ,the non-venomous snakes have a dentition very much the same as some of the smaller rodents1 the mice for instance4 ,the habitat frequently furnishes a key to the character of the snake4 ,the venomous varieties choose by preference the rocky uplands1 either open or sparsely wooded4 ,the harmless snakes live almost exclusively in low swampy lands or along water courses4 ,venomous snakes are purely terrestrial4 ,one was never known to ascend a tree4 ,in fact it is impossible for one to do so4 ,while rattlesnakes are dangerous1 their bite is not nearly so fatal as is popularly supposed4 ,this fact has at least two important reasons1 viz41 season and the habits of life of the snake4 ,in the extreme ,south and in midsummer the venom attains its highest state of virulence4 ,then the person fairly struck by a large rattler is in extreme danger1 provided the second factor in the equation does not intrude1 that is1 the habits of life4 ,all venomous snakes1 and more especially rattlesnakes1 are sluggish4 ,they do not move rapidly or over great distances4 ,their lethal power is given them as a means of procuring food and when once the snake strikes he expends practically all the ammunition in his arsenal4 ,it requires hours and perhaps days to renew the supply1 during which time the serpent is defenseless4 ,should the human victim happen along at such time and be bitten it is quite probable that he would not receive a fatal dose of the poison4 ,the manner in which the rattlesnake inflicts his wound is worthy of some study4 ,in the first place1 it may be assumed as axiomatic that the snake cannot strike farther than his own length and seldom even that4 ,stories of rattlesnakes lifting themselves from the ground bodily and hurling themselves through the air are purely imaginative4 ,nor can the snake strike unless coiled4 ,it does not follow that he must be in complete coil1 but he must have at least a few kinks in his spine before he can deliver a blow2 then he can only strike the length of the kinks4 ,if permitted he will assume full coil before striking and when undisturbed he lies in that position4 ,the maneuver of assuming full coil takes longer than is generally thought4 ,writers who assert that the snake can throw himself into full coil instantly are far from the truth4 ,in fact it takes1 on an average1 something like five seconds for him to get his length in position to deliver his most powerful blow4 ,my experiments have developed another interesting fact1 that the snake cannot strike an object held directly over his head4 ,it must be held at an angle4 ,how deep will the needle-sharp fangs penetrate4 ,that depends1 too1 upon conditions4 ,a large snake1 striking from full coil1 will naturally drive his fangs much deeper than another smaller1 striking from a less advantageous position4 ,upon the bare flesh the snake will sink his fangs to their full extent4 ,his blow1 however1 is often delivered with a raking motion and the wound inflicted resembles the scratch of a briar4 ,certain articles of dress are less permeable than others4 ,rubber1 even thin rubber1 is wellnigh impenetrable4 ,soft1 closely woven cloth is also resistent4 ,in experiments ,i have placed blotting paper behind two thicknesses of heavy flannel and only in rare instances have ,i found the virus staining the paper4 ,this fact will serve to inform the reader that the ordinary protection of the lower limbs will be adequate to shield the wearer in a rattlesnake country4 ,the chances of being bitten1 even in a country abounding in snakes1 are really quite insignificant4 ,the rattler is the most inoffensive gentleman of my serpentine acquaintance4 ,he is perfectly willing1 if you will permit him1 to lie all day basking in the sun upon some convenient rock and never molest the passer in the least4 ,if he has sufficient warning he will slip quietly out of your path and give you the right of way4 ,he only strikes when in his reptilian mind he deems himself insulted or in danger4 ,an extended discussion of the chemistry of serpent venoms would be manifestly out of place at this time4 ,we owe practically all our knowledge upon the subject to the painstaking efforts of two men1 ,s4 ,weir ,mitchell and ,prof4 ,reichert4 ,these gentlemen gave to the world almost simultaneously the result of their labors4 ,the lethal principle of all serpent venoms consists of two elements1 a venom peptone and a venom globulin4 ,these elements are albuminoid in character1 and it is interesting to note that they act no differently from the pure albuminoses of digestion4 ,one element has the power to destroy the fibrin ferment in the blood1 the other acts as a paralyzant upon motor and sensory nerve trunks4 ,time has no effect apparently upon the poisonous quality of these venoms4 ,after twenty years' preservation in glycerine ,dr4 ,mitchell found the virus as active as ever1 and it is known that arrows steeped in rattlesnake venom retain their power for many years4 ,heat in varying degrees1 or a sudden violent application of it1 will destroy the poisonous property1 as will also absolute alcohol4 ,the action of the virus on the animal economy is interesting and worthy of study4 ,when taken into the circulation the symptoms are quite characteristic and not easily mistaken1 even by the man of no scientific training4 ,this is well1 as the wound itself is insignificant and might be overlooked4 ,in fact1 ,i have known many persons to be bitten and not know it until the symptoms apprised them of the fact4 ,a stinging1 burning pain radiates from the wound and the wound itself becomes inflamed and angry4 ,swelling comes on1 the heart action is immediately accelerated1 and the respiration hurried4 ,in a short time1 as the virus penetrates deeper into the systemic circulation1 the heat and respiratory symptoms change1 the heart slows down1 the respiration decreases1 the face becomes dusky and anxious1 covered with profuse perspiration1 and the mind grows dull4 ,blindness1 due to the effect upon the optic nerve1 takes place4 ,the patient staggers as he walks1 and soon1 unless relief comes1 he will become totally paralyzed4 ,spots of blood appear just beneath the skin and especially upon the limb bitten4 ,if the amount of the virus is sufficient to produce death1 all the above symptoms are soon followed by tetanic convulsions and lockjaw4 ,if1 however1 the dose is not sufficient to produce death1 they gradually subside1 leaving the patient much debilitated and subject to poisoned blood states that manifest themselves in the form of skin eruptions and ulcers4 ,the reader will appreciate that in the above has been pictured an extreme case4 ,nothing like nearly all cases bitten present even half the symptoms described4 ,statistics reveal that only something like #ab per cent4 of all persons bitten by the ,new ,world venomous serpents die from their wounds4 ,before passing to a consideration of the means for combating a poison let us pause for a time and glance at the probabilities of being struck even in a country where venomous serpents abound4 ,the rim rock of the ,columbia ,river in ,washington and ,oregon is an ideal place for rattlesnakes and they abound there in profusion4 ,children run barefoot all summer among the basaltic rocks1 and but few of them are bitten4 ,haymakers fork them up with the haycocks1 harvesters find them beneath the bundles of bound grain1 still it is rare to hear of an accident4 ,among the brakes of the ,clearwater in ,idaho the great timber rattler dwells4 ,the ,indians never molest him1 yet during my nine years' sojourn among them only seven cases appeared1 and two of these were very young children4 ,still1 people are bitten1 and the location of the wound has much to do with the chances of recovery4 ,about #fj per cent4 of all persons wounded are struck on the lower limbs1 thirty-five on the hand or arm1 and five on the trunk and face4 ,of these1 wounds on the lower limbs are the least dangerous and those on the trunk or face1 being near large nerve and arterial vessels1 most so4 ,the more remote from the general circulation1 the less danger from the wound4 ,the treatment of a rattlesnake wound resolves itself into the application of a few very simple rules4 ,in the first place a person wounded by a snake usually does the very thing he should not do--that is1 goes tearing off at top speed for the nearest human habitation1 thereby increasing the circulation and disseminating the virus through the system more rapidly4 ,the man should sit calmly down and bind his handkerchief around the limb 7if it is a limb71 break off a stout twig and insert beneath the handkerchief1 producing a rude tourniquet1 and twist until the circulation is effectually shut off4 ,with a sharp knife make an ,x incision over the wound1 taking care to penetrate deeper than the fangs have done4 ,if he has good teeth and no canker in his mouth1 he may now suck vigorously upon the wound4 ,it does no good to suck the original wound4 ,it is quite difficult to get any virus back through an opening not greater in caliber than a fine needle4 ,if all this is done without delay1 the chances are that the patient will suffer no great inconvenience from his experience4 ,if he chances to have handy a stick of silver nitrate he can cauterize the wound thoroughly4 ,failing that1 a brand from the fire will serve4 ,after a time he may release his tourniquet somewhat and permit a portion of the retained blood to enter the circulation2 the system is capable of taking care of a great deal of poison if it is allowed to flow into the blood gradually4 ,if1 however1 the virus has been permitted to enter the circulation at once the case is one calling for radical measures4 ,in this connection it is well to state that alcoholics defeat the end required4 ,the time-honored belief in the efficacy of whiskey in the treatment of rattlesnake bites is pernicious in the extreme4 ,alcohol1 like serpent venom1 has two effects1 the later or depressant effect being exactly the same as the depressant effect of the venom itself4 ,therefore the man who recovers from a rattlesnake wound after drinking a large quantity of whiskey does so in spite of his remedy1 not with its aid4 ,the one sovereign remedy in these cases is strychnia1 and no man should penetrate a snake country without having this valuable adjunct with him4 ,the administration of strychnia is not so difficult but that any man of ordinary intelligence can inform himself about it in a short time4 ,it is a powerful alkaloid1 of course1 and must be applied with intelligence to accomplish the end desired4 ,how much to administer will depend upon the person and the character of the wound4 ,it must be taken into consideration that the system already poisoned by the venom will tolerate a larger quantity than one in a normal condition4 ,the average dose of strychnia hypodermically applied is #a_/cj of a grain4 ,this may be increased to say #a_/ae grain without any serious danger4 ,a person suffering from rattlesnake venom will bear without danger perhaps #a_/b grain or even more4 ,it will be understood that this amount is not to be thrown into the blood all at one dose1 but spread out over an interval of thirty minutes4 ,strychnia has its most important field in the treatment of these cases after the depressant effect of the venom has taken place4 ,the rule then should be to administer until the heart approximates the normal4 ,the patient can take too much1 then again he can take too little4 ,chemical antidotes directed against the venom of serpents are extremely problematical4 ,it is questionable if there is at present any chemical that will exert more than an antiseptic effect upon the virus4 ,permanganate of potassium may possess the property of setting up a chemical reaction1 but if so it is so prone to deteriorate when in solution and requires so much time to place in solution that it is nearly valueless4 ,ammonia applied to certain of the less dangerous venoms is efficacious4 ,applied to crotalus poison it is of no use4 ,in fact1 when the matter is reduced to its lowest terms1 the whole process of combating the effect of serpent venoms is comprised in what has been stated above4 ,restrict the circulation1 destroy the virus by heat either chemically or by fire1 and keep up the vital forces4 ,very few ,indian tribes have any suggestion of a remedy for rattlesnake poison4 ,the ,moquis probably have1 though if so no white man has ever been able to extract the secret from them4 ,it is known that during the ,moqui ,snake ,dance many ,indians are bitten and none of them die4 ,it might be inferred then that they do possess an effective antidote4 ,in conclusion permit me to suggest an equipment for the treatment of rattlesnake wounds and briefly outline its uses4 ,procure a rubber ribbon about four feet long1 technically known as an ,esmarch tourniquet--this ribbon can be rolled into a compact form and is very elastic--2 a sharp surgeon's knife known as a bistoury which should be securely wrapped in absorbent cotton2 a blue bottle1 or one about which several thicknesses of blue paper have been wrapped1 containing a stick of silver nitrate2 another bottle containing one hundred tablets of strychnia sulphate gr4 #a_/cj2 an all-metal hypodermic syringe for administering the same4 ,all these should be placed in an oiled silk bag and kept in a convenient pocket4 ,the bag should be changed when the clothing is changed just the same as the watch or compass4 ,now for their use3 ,let us suppose that you have encountered a rattler and are not too scared to know what you are doing4 ,you quietly sit down1 expose the limb1 locate the wound1 get out your ,esmarch and beginning at one end wrap it securely about the limb above the wound1 gradually increasing the tension until the rubber sinks into the skin4 ,this done1 take your knife and make a deep ,x over the wound1 using the cotton in which the knife was wrapped to sponge away the blood4 ,encourage free bleeding4 ,if you are near a stream bathe the wound freely1 either squeezing or sucking it4 ,you need not fear to swallow the poison4 ,it will do no harm in the stomach4 ,after the wound has bled freely1 take the stick of silver nitrate and burn it out quite to the bottom4 ,all of this will hurt1 of course1 but it is necessary4 ,the administration of the strychnia will follow next in order only if the depressant symptoms of the venom indicate its need4 ,should the patient feel the approach of the dizziness that is the beginning of the stage of paralysis1 he should then think about his strychnia4 ,dissolve one of the tablets in warm water and fill the barrel of the syringe2 screw on the needle1 first removing the fine wire that runs through it4 ,plunge the needle into the fleshy part of the arm at an angle of about ten degrees from the horizontal and push home the plunger4 ,repeat this every fifteen minutes until the heart ,has returned to the normal4 ,these directions closely followed will save every case of rattlesnake bite1 and in many instances the patient will not require the strychnia at all4 ,the wound made by the knife will require the same general treatment as any other simple wound4 ,,the ,,camper',s ,,medicine ,,chest ,,the ,,camper',s ,,medicine ,,chest ,surgical ,supplies ,one instrument roll1 #hj cents4 ,one paper medium size safety pins1 #aj cents4 ,one paper medium size common pins1 #e cents4 ,one-half dozen assorted gauze bandage1 size one-to three-inch2 #aj cents each4 ,two yards sterilized plain gauze in carton1 #bj cents yard4 ,four ounces sterilized absorbent cotton in carton1 #bj cents4 ,one roll three-inch adhesive plaster1 #a4 ,one-fourth dozen silk ligature braided1 in glass tube fitted with half curved needles1 #cj cents a tube4 ,one card braided silk ligature1 assorted on one card 7white71 about #cj cents4 ,one-half dozen assorted egg-eyed surgeon's needles1 half to full curve1 #ej cents4 ,one ounce ,squibb's surgical powder1 #ej cents oz42 or a like amount of camphophenique powder1 #a4 ,one hundred ,bernay's antiseptic tablets 7blue71 #be cents4 ,two five-inch hemostatic forceps 7,kelly's71 about #a each4 ,one pair straight1 sharp-pointed surgeon's shears1 about #a4be4 ,one needle holder 7,emmet's71 #b4ej4 ,one splinter forcep1 may be used also for dressing forcep4 ,this forcep should neither have mouse tooth jaws nor serrated jaws1 and should run to a fine point2 #ej cents4 ,one hypodermic syringe1 all metal1 in metal case1 #a4ej4 ,one one-minute clinical thermometer in metal case2 will cost about #a4be1 according to reliability4 ,the best registered instrument is cheapest4 ,one number #i soft rubber catheter1 #be cents4 ,one cake surgical soap1 in metal box1 #ge cents4 ,the above will comprise practically everything that may be found absolutely necessary4 ,with them the ingenious man can perform practically every minor surgical operation that he would care to undertake4 ,if he cares for a more elaborate outfit he may add the following3 ,one yard oiled silk1 in tube1 #ge cents4 ,one pure rubber fountain syringe1 #a4ge4 ,four ounces creolin1 in metal screw-cap bottle1 #be cents oz4 ,one or more first aid packages at #ej cents per package4 ,one emergency tourniquet1 #a4be4 ,eight ounces carron oil for burns1 #be cents oz4 ,the size of the surgical outfit will depend1 of course1 upon the size of the party4 ,the dressings and things that will be destroyed will necessarily have to be increased in proportion to the number of the party4 ,medical ,stores ,the suggestions here will be based upon a party of four staying one month4 ,in the case with the hypodermic place one tube strychnia sulphate1 gr4 #a_/cj1 price #bj cents4 ,use as a powerful stimulant hypodermically one tablet every four hours1 if needed1 watching the action of the heart carefully4 ,one tube cocaine muriate1 gr4 #a_/d1 price #ej cents4 ,use as a local anesthetic as suggested in chapter on surgery and for toothache4 ,can be used to control vomiting--one tablet followed by swallow of hot water every four hours1 if needed4 ,solution of one tablet in spoonful of hot water dropped in eye to deaden so as to remove foreign bodies4 ,one tube morphine sulphate1 gr4 #a_/d1 and atropine sulphate1 gr4 #a_/ajj1 combined1 price #be cents4 ,use as a sedative for pain1 one tablet hypodermically repeated every two hours to effect2 digitalin1 gr4 #a_/ajj1 price #be cents4 ,use as heart stimulant where action of heart is deranged1 one tablet not oftener than thrice daily4 ,one tube apomorphia hydrochlorate1 gr4 #a_/aj1 price #ej cents4 ,use to induce vomiting in cases of poisoning1 one tablet hypodermically only4 ,one tube glonoin1 gr4 #a_/ajj1 price #ae cents4 ,use as heart stimulant in shock and great depression due to cerebral anemia2 not in loss of blood1 however4 ,one sole leather medicine case with screw-cap glass bottles1 numbers etched on bottles1 price from #a to #c1 according to style and finish4 ,book to slip in pocket for keeping list of remedies and their therapeutic application1 cost #be cents4 ,the bottles filled as follows3 ,the numbering need not adhere strictly to that here given3 ,no4 #a4 ,aconitine gr4 #a_/acd4 #bjj at #be cents per ,c4 ,use in cases of high fever where heart is full and bounding and there is great congestion as shown by headache1 backache1 etc4 ,use in beginning of all colds4 ,take in all cases one tablet every fifteen minutes for an hour then one tablet every two hours1 or better still take every half hour until pulse becomes soft and surface of skin is moist4 ,no4 #b4 ,dosimetric ,trinity ,no4 #a4 #bjj at #ej cents per ,c4 ,one tablet every half hour to effect4 ,the effect will be to reduce all fevers much the same as above except that it may be continued over a longer time and becomes a routine treatment in typhoid1 pneumonia1 grippe1 bronchitis1 rheumatic fever1 and in all cases of fever where the heart seems to need a slight stimulation4 ,no4 #c4 ,intestinal antiseptic4 #ejj at #ej cents per ,c4 ,one tablet every three hours as routine treatment in typhoid1 diarrhea1 colic1 dysentery1 and all disordered fermentative conditions of the intestinal tract4 ,no4 #d4 ,quinine sulphate1 gr4 #e1 either in tablet or capsule form1 cost about #aj cents a dozen2 take #ajj4 ,use in malaria1 one tablet every four hours during attack and not less than fifteen grains daily as a preventative4 ,in decidedly malarial countries this amount will have to be taken daily1 consequently the amount carried should be materially increased4 ,is somewhat valuable in colds1 bronchitis1 etc4 ,no4 #e4 ,sun ,cholera4 #ajj at #ej cents per ,c4 ,one tablet every four hours in cases of watery diarrhea1 after bowels have been cleaned out by purgative4 ,of use also in colic1 flatulence1 intestinal pain4 ,no4 #f4 ,chlorodyne4 #ajj at #a4jj per ,c4 ,take one tablet every two or three hours in extreme pain1 vomiting from fermentative processes1 summer diarrhea1 etc4 ,no4 #g4 ,calomel1 gr4 #a_/d4 #bjj at #aj cents per ,c4 ,use one tablet every thirty minutes or every hour for eight doses1 in all cases where bowels need thorough cleaning out4 ,as beginning treatment in all cases of fever1 vomiting1 diarrhea1 in fact about everything that happens4 ,no4 #h4 ,phenacetine1 gr4 #e4 #ajj at #ej cents per ,c4 ,one tablet every four hours to reduce fever as in colds1 some forms of dysentery1 and in severe headache4 ,to be discarded when case bids fair to become prolonged4 ,no4 #i4 ,elaterin1 gr4 #a_/af4 #be at one cent each4 ,use one tablet only where it is necessary to secure an immediate watery passage from the bowels in order to sweep out offending masses4 ,no4 #aj4 ,dover's powder1 gr4 #e4 #ajj at #ej cents per ,c4 ,use one tablet every four hours in sudden acute colds4 ,its most valuable field is in the colds and bronchitis of children4 ,continue until perspiration ensues4 ,in case the medicine case holds more than ten bottles the additional bottles may be filled with brown mixture1 #ajj at #be cents per ,c4 ,one tablet every four hours to one three times a day in cases of indigestion1 flatulence1 sour stomach1 etc4 ,headache tablet consisting of acetanilid1 sodium salicylate1 ammonium bromide4 ,a choice tablet to be given every four hours where persons are subject to congestive headaches4 ,the least objectionable of all the coal tar tablets4 ,these may be had at about #be cents per dozen1 and the case should contain at least #ajj of them4 ,tonsilitis tablet consisting of menthol1 thymol1 phenol1 potash1 chlorate1 and sodium chloride4 ,take #bjj at about #be cents per #ajj4 ,use as a gargle in tonsilitis1 sore throat1 and pharyngitis4 ,dissolve tablet in half pint hot water and gargle several times a day4 ,it will be noted that in the above unnumbered list aconitine and ,dover's powder have been substituted for apomorphia hydrochlorate and digitalin recommended in ,chapter ,,iii4 ,either list is good1 and will be found comprehensive for all ordinary emergencies4 ,,the ,,end 99 99 99 99 99 ,transcriber's note3 ,italics is represented with underscores and small caps with ,,all ,,caps4 ,ambiguous hyphens at the ends of lines were retained4 ,the following corrections have been made3 p4 #ae it is unnecsary - unnecsary changed to unnecessary p4 #df cavity as it probably has7 - added opening bracket 7as it probably has7 p4 #ii sodium salycilate - salycilate changed to salicylate ,everything else 7including inconsistent hyphenation and archaic spelling7 has been retained as printed4