ACCIDENTS—BMEROENCIES — POISONS. 77 slowly that the necessary purification for the demands of the body does not take place in the lungs. Medicines of the aromatic and pungent character, combined with others containing Opium arc usually given. There are many popular things of the kind. The following combination is as useful as any : Aromatic Sulphuric Add, 1 yy^ 3d drops. Tincture of Capsicum, j Tiucture of Opium, 1 ^ i guid dram. Tincture of Camphor, I Tincture of Gingor, 2 fluid drams. Compound Tincture of Cardamom, 10 fluid drams. Mix. ^ A tea-spoonful in a table.spoonful of water, every hour, two hours, or three hours, until the patlen', seems better. Or It might be given every halt or every quarter of an hour.* As might be expected, under the circumstances, absorption of medicines or food takes place slowly, and no surprise need be felt if immediate improvement docs not at once take place during the attack. No time should be lost in an attack, in trying to arrest the evi- dent tendency of the blood to seek the bowel, by diverting it out- ward by applications of heat in various forms. Hot flannels, ves- sels of hot water, with stimulating applications, diligently used to the body and limbs, and friction by the hands, moving them from the extremities toward the heart, should not be omitted. There is great thirst, owing to the rapid abstraction of the wa- ter from the system, and small pieces of ice and little water may be given every little while. Cholera is not a contagious disease, nor is it near as fatal as gen- erally believed. Many die, it is true, but because so many are at- tacked. As long as there is any life, there is hope in this affec- * This mixture can be made by any apothecary, or compounded from the usual medicines kept on hand by most families. It keeps well, is not impaired by age, nor disagreeable to the taste, and is compact in bulk. As a prudential measure, it might be placed in a hand-satchel in traveling; where a change in the water brings on at- tacks of diarrhoea. 78 ACCIDENTS——EMERGENCIES——POISONS. tion, and people who have been considered dead have revived and lived. During the prevalence of an epidemic of this disease, especially in the case of strangers, the final steps preceding inter- ment should never be taken without the most positive proof that death has really taken place. CHOLERA. MORBUS. The symptoms of this attack arc so much like Cholera, as often to suggest the epidemic. There are violent movements in the muscular coats of the entire intestinal canal, giving rise to great pain; expulsion of the contents of the stomach, known as vomit- ing ; and of the contents of the bowels, known as diarrhoea. The cause usually can be traced back to an excess of ordinary food, or the use of articles incapable of digestion in tlie condition of the system usually found towards the end of summer. Drinking freely of water, by further weakening digestion, materially aids it. Cholera Morbus is a natural process, and tends to relieve itself as soon as every thing in the canal shall have passed away, and the tract has had an opportunity of recovering from the special exertion. Paregoric, Ginger, and such things are to be used. In- deed, the treatment named for Cholera is safe and useful. Care will prevent an attack. DIARRHOEA. For the practical purpose of this little treatise, it may be said that ordinary Diarrhoea of warm weather is a milder effort, than in Cholera Morbus, of the digestive tract to get rid of irritating substances, and may be treated in the same way. DYSENTERY. This is often epidemic, and quite fatal. In ordinary cases, the symptoms are that of severe Diarrhoea, with griping and strain- ing. In a general way, it may be stated that this straining, after each evacuation, is the distinctive symptom between Dysentery and Diarrhoea; showing that the large bowel, or rather the extreme ACCIDENTS— -EMERGENCIES——POISONS. 79 portion of it, has become irritated and inflamed. An injection of twenty-five drops of Laudanum in a little thin-cooked starch, every few minutes, will often relieve this very distressing symptom. "What is better, as a matter of convenience, is a one-grain Opium suppository as frequently. The prescription given under "Cholera," or its equivalent, may be given as there directed. TO CHECK VOMITING. '. If due to mere irritability of the stomach or nervous system, the Aromatic Spirits of Ammonia, in twenty-drop doses in ice-water every few minutes, iced Mineral-water, iced Champagne, thirty- drop doses of brandy, every few moments, a mustard-plaster, cayenne-pepper plaster, broken ice in a bladder to the stomach, or opposite, over the spine, are all useful. The last often succeeds where other things fail. A common tumbler with fragments of paper dipped in Alcohol or Cologne, and ignited, to act as a " cup," ased to the pit of the stomach, is likewise useful. Sometimes the vomiting is a proper effort to get something out of the stomach that ought not to be there. If this is known to be the case, assist it with a solution of salt and water, or pulverized Ipecacuanha, ERUPTIVE FEVERS. Under this head are several distinct affections, but with several general features in common up to a certain point. They are all infectious and contagious—that is, by absorption of tainted emana- tions from the affected person through the air, and by direct con- tact. From the time of absorption of the poison into the system, a, period of incubation exists, then constitutional disturbance of the; system, ending in the appearance of a distinctive eruption. This, runs a well-defined and natural course, which can not be cut short. The natural tendency of them all is to run a favorable course, but sometimes there is a peculiar condition of the blood of the people of the community inviting the disease to an unfavorable end. Often, again, an individual peculiarity docs the: same, and, ),t 80 ACCIDENTS——EMERGENCIES——POISONS. can be seen that a person prepared 'by these two things, especially if living in bad air and on poor food, is not at all well off in the presence of an attack. The distinguishing feature of this class of affections appear to be the eruption ; so they are presented for pur- poses of comparison: Period of incubation Appearance of commencement of evi- and latency, from dent constitutional disturbance,, Scarlet fever, 4 to 8 days. 18 to 24 hours. Measles, 7 to 8 " 72 hours. Small-pox, 8 to 14 " 48 " Scarlet Fever. Scarlet Fever (called Scarlatina by physicians, which is not, ae some people think, from the termination of the word, a mild case of the disease) appears with the symptoms common to wliat are known as the other eruptive diseases, Measles, Small-pox, Chicken-pox, and Erysipelas. Few children live to the age of six- teen months without having had all the general symptoms, and the case turning oi:t only a " cold." There appear more or less headache, symptoms of oppression and weakness, as if the strength were gone, flashes of heat and shiver- ing—sometimes the latter can be called the chill found in the whole class of eruptive diseases. In from eighteen to twenty-four hours, an eruption appears over the skin, of a bright scarlet color, not crimson; much the color of a boiled lobster. Pressure of the finger to one spot, leaves a white point or stripe, remaining for some moments after removal of the force. It is often difficult to tell Scarlet Fever and Measles from each other. Between them are the following points of resemblance : IN BCAB'LKT FBYEK. The eruption is a bright scarlet. Appears on the second day. The eruption does not seem raised to touch. Blotches of uniform tint, Disappear on pressure, ACCIDENTS——EMERGENCIES—POISONS. 81 (To mucous discharges from the eyes and nostrils. No sneezing or sensibility to light. No hacking cougli. MEASLES. . The eruption is a cherry red or crimson color. Appears on third or fourth day of disturbance. Seems elevated above surrounding surface of skin. Arranged in irregular or crescentic masses. Does not disappear, leaving white spot. Face swollen, discharges from eyes and nostrils. Sneezing, hides eyes from the bright light. Frequent hacking cough. Besides attacking tlie external skin, the scarlet-fever poison ap- pears to be precipitated also upon the mucous membrane of the throat, especially about the mass of secreting depressions there, known as tlie tonsils. Measles does not. In "sore throat," which is an inflammatory activity in the same parts, without the specific poison under notice, much the same appearance presents to the uneducated eye. And if there should be a " cold" affecting the general system, enougli general symptoms often occur, to suggest during tlie prevalence of tlie disease in a neighborhood, the feared malady, but the absence of the described eruption decides the case. In the course of a few days, the inflamed skin comes off in scraps and shreds. The under skin is naturally quite tender and sensitive to the cold air ; and the physician never fails to impress upon the attendant the danger likely to occur from it. While plenty of the purest air must be kept in the room, it had better pass through an adjacent chamber to deprive it of the "draughty" character. After the new skin shall have become complete in structure, and the broken-down condition of the blood common to this as well as the other eruptive diseases, shall have been noticed, these precautions may be relaxed. Until the arrival of a physician, warm, acidulated drinks, as lemonade, may be given, and the other popularly esteemed things done for "bringing out the rash." Sponging the parched and 82 ACOIDBNTS——EMERGENCIES——POISONS. inflamed skin with a soft sponge, well wrung out in cold water, is not only grateful, but useful to the patient. As no person ever thinks of attending a case of scarlet fever without professional advice, nothing will be said about the treat- ment. It may be added, however, that the poison alters the char- acter of the blood in such a way as to give the kidneys a great deal of trouble for a time ; so care must be taken to prevent chill- ing of the surface of the body in any way by forcing the blood inward upon these already overtaxed organs. The liquid which can not be excreted (thrown out) by the kidneys oozes out into the vacant spaces of the body, and is retained there under the name of dropsy. The scarlet-fever poison, as we may term it, not only attacks the skin and visible mucous membrane of tlie throat, but extends to the unseen extensions of it to the large mass of communicating cavities back in the head, above the roof of the mouth, where the throat and nostrils meet. The inflammation travels along the canal (custachian tube) on each side leading from the throat to the in- side car, leading to such a mechanical derangement of the parts as to damage the hearing. For obvious reasons, the worst of it is that any thing like special prevention is out of the reach of the medical attendant. Scarlet fever is highly contagious, and the room of the patient should Iiave all hanging articles and unnecessary pieces of furni- ture removed to prevent adhesion and preservation of the germs of the disease. Measles. Measles is ushered in with much the same general symptoms as scarlet fever. The points of difference between the two affections have been pointed out. In measles, the rash appears rather in Uotches, which can 'be seen to be made up of little irregular, crescent- shaped crimson spots, unlike the uniform, scarlet distribution of the eruption of scarlet fever. The eyes and nostrils discharge ACCIDENTS——EMERGENCIES — POISONS. 83 mucus, there is sneezing, a cough, and a dislike to light, not seen in Scarlet Fever. The treatment consists in preventing exposure until removal and restoration of tlie skin to its natural duties. Sometimes the blood docs not seem to readily return to its normal character, and the health remains impaired. This is often the case where the general health was not good before tlic attack. The clicst symp- toms point out a tendency, upon slight provocation, for tlie lungs to become troubled with catarrh and kindred disorders, unless due care is taken. Warm teas of Saffron, and the garden licrbs, arc usually given as domestic remedies to "keep out the rash." and often this is all the treatment the child gets. Small-Fox. The general symptoms of small-pox are more violent than in either of the named affections. The fever, and especially the pain in the small of the back, are strongly marked. There is thought to be a general relation between the urgency of these symptoms and the amount of eruption that should appear. In the early stage, it is not always an easy matter to tell by tlie sight alone the eruption of Small-pox from that of Measles. The rash of Measles offers DO special resistance to the touch, while in Small- pox it seems rougli, as if a layer of minute mustard-seed were scattered under the skin. Later, the minute red pimples become marked at the apex by a pearly point, changing still later to a pustule with a central black point, giving an optical appearance of depression in the centre. The appearance of the eruption should be favored by careful attendance and a free use of warm drinks. "Pitting," as it is called, can often be prevented to a considerable degree, but the tendency to use the nails to the face, at certain late stages, almost neutralizes the best efforts of the physician, unless the nurse gives close attention to the patient. Small-pox is not to be cured, but to be prevented. There is no 84 ACCIDENTS——EMERGENCIES—POISONS. doubt as to the reliability of Vaccination to do this. If it does not prevent the disease altogether, as it does in most people, the attack is so modified that death almost never takes place. If the vaccination has "run out," of course the person is little better off than if he never had been protected. As there is no uniformity among the people about this, each person probably sliould have vac- cination attempted, every few years—say five or six. If pro- tected by the previous attempt, it will not "take," and if partially protected, the effort probably completes it. The virus from re- vaccination, even if it "takes," should never be relied upon for other people, when that from a first vaccination from small chil- dren can be had. The appearance of an epidemic, like tliat just passed through, was due to a feeling of general security upon the subject permitting an accumulation of material on hand adapted for an attack. That a few people in this large community are op- posed to Vaccination, on "conscientious scruples, "is no argument whatever against its usefulness. The writer believes, from ample observation, that the greatest care is taken by physicians in avoiding possible sources of error in selecting crusts for use. It is not thought that diseases can be transmitted in that way, although the practice among physicians very properly is to act as if they might. While the writer has seen eruptions appear after Vaccination, he has seen the same after a cut; and in a large experience, in connection with public institu- tions, he has never seen a case of transmission of disease by it, nor does he personally know a physician whose opinion in other matters is of value, who has. Well-asserted cases doubtless exist, but they are not more re- spectably vouched for, than the statements made when Vaccination was first introduced to the public by Dr. Jenner, that horns from the head and hoofs from the hands, had followed the efforts of that very useful man. Varioloid, or the disease modified by Vaccination, is contagious to a very susceptible person; and some persons are so susceptible ACCIDENTS—EMERGENCIES—POISONS. 8S that frequent Vaccination does not always secure exemption from exposure to even a small amount of the emanation. MALARIA. Malaria is an intangible and almost undefinable product of heat, moisture, and decomposing vegetable matter, which, when ab- sorbed into the blood in sufficient quantities, gives rise to certain well-known symptoms termed intermittent—that is, at certain calculable, recurring periods, more or less fever occurs, with more or less chillincss. Instead of both or either of these sensations, it is another, as pain in some part of the body. In the United States, wherever heat and moisture are able to decompose vegetable matter in a certain manner. Malaria is found. In summer, it is not prevalent, probably because the fresh life of such matter successfully resists the peculiar decomposition. Later, in the early autumn, before the killing frosts, it abounds. The temperature of evening and night favors its production, and as the vital powers are then somewhat weakened from the labors of the day, this is a favorable time for absorption into the body. A moderate temperature seems to invite its formation, perhaps by furnishing tlie necessary quota of moisture. The heat of the sun, or of a common fire, discourages the production, hence localities c".n be visited at midday, usually avoided at other times; and heating the air of a house by a fire, is a well-known precaution. As vegetable matter and moisture exist in greater abundance near the ground, the lower strata of air soonest become saturated, and the air as high up as the second story often contains much less. Malaria is about the same density of common air ; so it travels for a certain distance entangled in tlie volume of atmosphere in which it originated. Hence, a gentle breeze carries it to spots where not produced. In passing a mile or so over an active stream or other non-producing surface, unless especially virulent, Malaria becomes so diluted or dispersed as to lead to the practical belief that this distance affords, under ordinary circumstances, a safeguard from its influence. Trees, or other solid substances, may 86 ACCIDENTS—EMEBflENCtES—t'OlSONS. act as a screen to a spot; hence removal of such barriers often extends the influence of the poison. If generated about a dwelling, trees or close shrubbery, by keeping out the heat and light of the sun, may prevent the diffusion of the produied Malaria to a more desirable area. The upper stories of a house near the place of forma- tion may escape, because elevated above the diseased layer of air, but a house on a bluff, a mile or so off, may suffer because the im- pregnated volume of air moving along the ground may be rolled up the elevation to the dwelling at the edge of the heiglit; but passes above, by deflection, a dwelling a little further back. In places where Malaria exists, or during the season, and under circumstances where it should be intelligently feared, rooms above the ground are furthest from active production, and these, with windows opening towards the same places, should be avoided. Doors and windows of houses possibly liable to the introduction of it should be closed before sunset, and kept shut during the entire night. The outside air is not pure air, but can be made free from the poison by passing through a room heated by a fire. The air from near the ground sliould be avoided, as the time suitable for production comes with the diminished lieat between early sun- set and high sunrise next morning. As absorption by the blood, for simple reasons, is most active, the vessels are not distended witli the products of recent digestion ; tliere should be no unnecessary exposure in the morning until after a full breakfast. Surface water containing vegetable ' matter must be carefully avoided for drinking. All things favoring a reduction of the vital powers, invite the absorption of Malaria, and especially secure all its disadvantages. A shallow swamp or damp ground produces the poison, while deeper water or a running stream need not, because deep water docs not permit the growth'of tlic required amount of vegetable matter. A newly drained area, exposing much succulent vege. table material in the bottom to the heat of the sun, leads to it; or turning up the surface earth to the same influence will do the