ACCIDENTS—EMERGENCIES—POISONS. 87 same. Malaria has been known to appear along a line of newly- thrown-up public works, executed toward the end of summer. The damming of a stream often introduces it into a neighborhood; and, what is worse, is the removal of such a work of long stand- ing in hot weather. A heavy rain will often, for a short time, interrupt the production, and a frost heavy enough to destroy rank vegetation gives relief. These are all degrees of susceptibility, both natural and acquired. Some need but, little to feel its effects, others more. In temperate latitudes, the result is "fever and ague," at the Isthmus, the annually-recurring " Chagres fever," and on certain coasts the rapidly fatal "African fever." With typhoid poison in the army, the result was the disastrous " Chickahominy fever," and with the defective drainage of Havana and New-Orleans, "yel- low fever." In all these, malaria is an active and hurtful auxi- liary. The poison rapidly exerts a destructive action, of no brief dura- tion, upon the corpuscles and other prominent features of the blood. The blood is prepared by a previous absorption for a sub- /quent one at another season. Under this acquired susceptibility, a fraction only of the original quantity is necessary to induce an attack of intermittent fever—a quantity which might not prove observably hurtful to an ordinary person. In the South, a person is spoken of as "acclimated," a term originally used, perhaps, with grim humor, to refer to an individual not quite killed by it. Where business or other things will not permit the observance of all necessary precautions in localities where Malaria should be feared, Quinine and its related salts act as an antidote. Like other antidotes elsewhere spoken of, the amount must bear a re- lation to the amount of poison to be neutralized. The antidote can not undo what has already been done—that is done by nature, in the absence of more of the poison, under the direction of a physician. One of the first observable symptoms of malarial poisons is a 88 ACCIDENTS—EMERGENCIES—POISONS. sense of slight chilliness, preceded by "yawning" and stretch, ing" at a certain part of the day. "With it is a sense of ill-defined debility and indisposition to mental exertion. These symptoms are often more evident, for obvious reasons, to a friend than the victim. The Sulphate of Quinine in two-grain doses, on aris- ing and retiring, should be used as a precautionary measure. Sul- phate of Cinchonia and the Sulphate of Cinchonidia, salts left in extracting the earliest discovered Quinia from the Cinchonia(" Peru- vian") bark, in somewhat larger doses—say one-half—are quite as useful as the much more expensive Sulphate of Quinia. When there is a complete interval between the paroxysms, the attack is known as intermittent fever, "chills," or "fever and ague;" where there is only a remission in the symptoms, it is Re- mittent fever. After an attack of either, especially the former, it is almost necessary to restore the blood by tonics and such things, and then, during the entire season of malarial production, one of the named anti-periodics must be used every seven or fourteen days to neutralize the peculiar tendency to recur at such periods. POISONS. Under this term, people are inclined to place only those things which, if taken internally, produce death. Physicians, however, consider it merely a relative term, and call any thing a Poison that does more harm than good to the body. A little of a good thing may be useful, but, beyond the point of usefulness, may be inju- rious. An exaggerated injury, from the same cause, may well be termed a poison. There is not a single poison in the entire list which, in proper quantities, and under favorable circumstances, may not be used with advantage to the human body ; and, on the other hand, there is scarcely a single thing in ordinary use, which if indulged in beyond the requirements of the body, or its ability to properly dispose of it, may not be followed by symptoms of derangement of the economy; and, in the above qualified sense is not miscalled, if termed a Poison. ACCIDENTS—EMERGENCIES—POISONS. 89 In the majority of cases, the poison is introduced into the body through the stomach. As soon as swallowed, a portion of the a°'cnt may commence destructive action upon the mouth, throat, or stomach, as in the case enumerated of Acids, Alkalies, Arsenic, Phosphorus, etc. "While some substances act in this way, others pass from the stomach, through the mucous membrane, without injuring it, into the blood, and are carried by it to the brain and I'ther portions of the nervous system, where the really injurious a. tion begins, by overpowering them ; so that the breathing and action of the heart are not kept up. To this class of poisons belong Alcohol, Acanitc, Belladonna, Opium, Strychnia, etc. A slight knowledge of the mode of action of a substance will, therefore, of itself suggest an antidote or remedy. If an Alkali has been taken, an Acid will neutralize it, coverting it into a compound less hurtful. The new compound is, perhaps, injurious, but not so active, and can be removed from the stomach somewhat at leisure. On the other hand, if an Acid has been taken, an Alkali would naturally suggest itself as an antidote. Some substances can not be neutralised by any convenient article ; tlie poison is then to be removed from its lodging-place as soon as pos- sible, and its effects counteracted. If the agent does not act upon the stomach directly, but upon the brain and nervous system, reaching it tTirougJi the blood, a re- collection of what was said when certain gases have been inhaled will meet the case. Artificial respiration would, of course, be re- sorted to. This should continue until enough of the poison in the blood has been eliminated (thrown out) by the natural pro- cesses constantly going on in the body, until the brain and nervous system are able to resume one of their old duties, of attend- ing to the respiration and circulation of the blood. As few persons have the necessary knowledge of the different poisons, each of tliese substances will be spoken of somewhat in detail, and alphabetically arranged, so that, in case of need, im-. 90 ACCIDENTS——EMERGENCIES——POISONS. mediate reference can be made to the particular substance supposed to have been taken. Before saying any thing further, it should never be lost sight of, that the substance swallowed as a poison must be considered as three parts: the portion of that taken which has already had an opportunity of acting upon the mucous membrane (lining) of the tliroat and stomach, if the poison acts in tliat way, or which has already passed from the stomach into the blood, if the poison acts in tlie other way ; and the portion of tlie poison in the stomach yet to be disposed of. It is tlie latter portion, perhaps, in most instances, we are called upon to first deal with ; and the means employed is, to evacuate tlie stomach with the least possible loss of time. This is done with the stomach-pump and by emetics. Stomach-pump. No directions for poisons are complete without reference to this piece of apparatus. With people who know nothing about the matter, it is very popular. The writer knows of but one physi- cian among all his acquaintances wlio professes to keep one, and unless this particular instrument is different from all other com- plicated instruments rarely used, he does not believe the owner of it could get it to work in an emergency, if lie wished. Not a single apothecary, as far as he knows, keeps one ; and the writer does not know, among all his intelligent acquaintances, a single non-professional person who could use a stomach-pump with suc- cess if he had a dozen of them at his command. A handful of salt and a tumbler of water can always be had ; and any body can mix a heaping teaspoonful of ground mustard with a cup of water, and get a person to swallow it. Either, swallowed, will empty the stomach ; a " stomach-pump " will do no more. As has probably been observed, the simplest things, and those most likely of all others to be liad everywhere, are tlie ones only spoken of in this pamphlet. The same purpose carried out at this ACCIDENTS—EMERGENCIES—POISONS. 91 point, leads us to say nothing now about the stomach-pump ; and, for the same reason, it possibly will not be referred to again. EMETICS. For the purpose of rapidly emptying the stomach in the decided majority of cases, before the arrival of a physician, and after it too, there is nothing like an Emetic. The easiest had, also, is usually the best. There are few places where these things can not be had—Ground Mustard, Common Salt, and Warm Water. GROUND MUSTARD.—Take a table-spoonful, mix with a tumbler of water to about the consistence of milk. Give the person one- fourth of it at once. Then follow with a cup of warm water. In about a minute, give the person the same quantity again, followed by the warm water. If vomiting does not take place, continue giving until it does, letting a minute or so pass betwen each dose. Plentiful draughts of tepid water materially assist the action of the emetic, and the free use of it should, therefore, not be omitted. Mustard is not only useful as an emetic, easily found, and as readily given as any thing else, but it is stimulating in character. This feature gives it a peculiar value in most cases where an emetic is demanded, for there is often, with the necessity of its use, a stimulant needed. The amount derived from Mustard is not always enough ; sometimes it is ; but when not, so much lias been contributed. COMMON SALT is even easier had than ground mustard, and is as certain in action. It is given, a teacup of water with as much salt dissolved as the water will hold, every minute or so, until vomiting occurs. WARM "WATER, given cnp after cup, is a safe emetic; but as the duplicate above mentioned articles are so easily had, it is rarely relied on alone for the purpose. Usually it is given to assist the action of tlie others, on the principle, perhaps, that a distended stomach is often more easily emptied than one with little in it. After vomiting has occurred, frequent draughts of warm water are ^ ^CIDENTS——EMEIiGEMCtES— POISONS. often given to cleanse out the stomach. In many instances, for this purpose, warm milk, gum-arabic water, flour and water, the white of an egg iu a teacup of tepid water, and such .substances are given instead, with the expectation that their gummy viscid properties fit them to entangle and detach particles of the poison adherent to the mucous membrane (lining) of the stomach Besides, they are soothing to the perhaps irritated condition of the parts. TICKLING THE OTSIDE OF THE THROAT by the finger, or witli the tip of a feather, in many instances, alone will induce vomiting. Usually, after an emetic has been given, this is used to hasten its action. SULPHATE OF ZCTC is another valuable emetic often found in private-houses. As much as will lie heaped up on a common two- cent piece is twenty grains, which is a dose, whc.n dissolved in water. This quantity should be given at a single draught fol- lowed by a cup of tepid water, and repeated every three minutes until three or four doses have been taken, or vomiting occurs. If there is none in the house, send to the nearest apothecary for sixty grains of the Sulphate of Zinc ( White Vitriol"). Empty the package containing this quantity into half a pint of tepid water Stir rapidly with a stick, and it will soon dissolve. One third of this half-pint should contain, of course, twenty grains of the sivty put in, and that quantity should be given at a single draught fol lowed, as all emetics should be, by droughts of tepid water ' In a few minutes repeat, as directed about Mustard, unless profuse vomiting takes place. PULVEMZED IPECACUANHA Is another valuable emetic, particu- larly for children. It can be had of any apothecary by a messenger. Sixty grains (one drachm) of it may be requested. It is a ground root, and, as would be expected, does not dissolve in water but mixes with it, like ground Mustard. One third of the sixty grams, which is twenty grains (as much in bulk as will heap up a two.cent piece) may be given, mixed with a small teacup of tepid water, followed by- a draught of tepid water. In a few moments ACCIDENTS——EMERGENCIES——POISONC. 93 if vomiting docs not occur, give another third, as you gave the first, to be followed in sixty seconds more by the last. A good deal of trouble is often experienced in getting the person to swallwo. This may be duo to insensibility, fright or stub- bornness. The thumb of each hand may be slipped in outside and close against the teetli, along tlie line of junction, until the spot is reached beliind where there are no teeth. Then through that vacant space slip the tips of (lie thumbs in between the jaws, wlien a separation can be readily effected. The thumbs should be kept there, for tlie patient can not bite the attendant wliile his fingers are in such a position, and the handle of a strong iron or silver spoon, or piece of smooth stick, thrust back far enough to forci- bly depress the tongue. The liquid can then be poured down the throat, if tlie person is lying on his back. At first it would fill up the space at the base of the tongue, but a little more depression of the tongue by the leverage given by tlie spoon or stick will cause it to run down the throat. There need be no fear of the fluid get- ting into the windpipe, for a very sensitive valve over the entrance of the trachea (windpipe) amply protects it. The first vomiting, as said before, does not necessarily clear the stomach of its contents. Much of the poison may remain adherent to the mucous membrane, requiring frequent 'washings, as it were for detachment and removal. After the first vomiting, there ii? usually little trouble in keeping it -up, by simply giving plenty of tepid water. Warm water alone is often, as said above, an Eme- tic ; and when none of the mentioned things can be had, must be wholly relied upon for the purpose. Before the action of an Emetic can begin, a portion of the poison usually escapes from the stomach into the contiguous bowel. No vomiting can affect it; so, after the contents of the stomach have been removed by the action of the Emetic, it is always well, if the poison belongs to what is called, for convenience, the Mineral class (p. 83), to administer good quantities of milk, which, passing down, engages the activity of the poison. Flour and 94 ACCIDBNTS—EMERGENCIES——POISONS. water will answer, but what is better, perhaps, is the white of eggs, mixed with -water. Now, we will suppose all the poison has been removed by the above efforts from the stomach. The next thing is the removal of the consequences of the portion of the poison which has already com- menced its work. If the mucous membrane has been injured, it should have rest from its usual work—digesting food—and be treated by suitable soothing applications, as barley water, gum- arabic water and such things. This should follow where the poison- ing is due to any of the articles embraced in the first class of sub- stances treated of. POISONING BY MUSHROOMS. Persons not well acquainted with the differences between the poisonous and edible Mushrooms had better buy them of those who are, or go without. There are distinctions between them, but they are not of such a character as can be made evident in a place like this. "When poisoning from eating Mushrooms does take place, the contents of the stomach should at once be evacuated by an Emetic. (See page 91.) After vomiting has commenced, it should be pro- moted by draughts of warm water, barley water, but particularly by drinking copiously of warm milk and water, to which sugar has been added. What has passed along into the bowels should be hurried out as fast as possible, by some carthartic, before further absorption into the blood can take place. Castor Oil might be peculiarly useful in such a case. If there is much prostration of the strength, some easily-procured stimulant might be useful, as the Aromatic Spirit of Ammonia, or Brandy. POISONOUS MEATS. Eating meats of diseased animals is often followed by symptoms of a poisonous character. Animals in otherwise perfect health ACCIDENTS —EMERGENCIES——POISONS. \)5 but which have been butchered and prepared for -food after long and exhaustive confinement, are unfit for caling. Not only is the meat of such animals lacking in nutritive character, -when com- pared with the meat of animals killed from the pasture without excitement, or after being kept until proper recovery from the effects of tlic journey to market, but it is much less savor)7, and shows a disposition to much more readily decompose. It might be liere stated tliat it has been estimated by competent authori- ties, that between the two kinds of meat there is, in a commercial sense alone, as far as nutriment is concerned, a difference of nearly fifty per cent in favor of the meat of healthful animals, butchered after complete recovery from tlie excitement and fatigue of drive or carriage to market. The additional cost per pound of meat to cover the expenses of extra care and precaution before butchering, would amount to but a small fraction of the per- centage named, leaving the rest of it a true profit to the con- sumer. The eating of this overdriven meat, it is said, is often followed by symptoms of irritation of the stomach and bowels ; but they can, in (lie ordinary sense of the word, scarcely be said to be of a poisonous character, however much tlic use of tlicm may temporarily derange the health. POISONOUS FISH. Several varieties of Fish, at all seasons of the year, are reputed to be poisonous. Of course, they should always be let alone. Should they have been eaten by accident, the best treatment is that given under the head of " Poisoning by Mushrooms," p. 94. Shell-fish, at certain seasons of the year, after spawning, are considered poisonous when eaten ; at least, they are unhealthy. I'his process of nature is known to be very exhausting; during which, or just afterward, the individual is so reduced in vitality as to be unable to resist ordinary tendency to decomposition. Oysters in hot weather are often unwholesome, perhaps from the causes suggested; or it may be that the collection of liquid QC --'" ACCIDENTS—— EMERGENCIES—— POISONS. secretion between the shell and the contained animal, in hot weather _s in a state favorable to putrefaction upon slight exposure to the air; and the disagreeable symptoms often said to arise after ^tak,ng of this fish as food is due to this as much as any thing MINERAL POISONS. ALKALIES, ALKALINE EARTHS, ACIBS, METALS, Etc. Ammoni.i. The ordinary Aqua Ammonfae, sometimes known as -Harts horn,- acts on the mucous membrane of the stomach, as would naturally be expected after knowing its effect upon the mucous membrane of the nostrils. When swallowed, it acts as a rapid corrosive poison. Owing to its pungency, it can scarcely be given bynustake in a state of purity. With Olive Oil, it forms the common Hartshorn Liniment," and has thus been given internally A violently.acting corrosive substance, like Ammonia, leaves no time for Emetics. It is an Alkali, and the common dilute Acid known as Vmegarwill neutralizeit. Lemon-juice also would answer the purpose. Other concentrated alkalies, as Lime, Soda, and Potash, act in the same manner as Ammonia, and when taken internally must be combated in the same way, and with the same difficulties in view. Mineral Acids. The common Acids, Acetic, Muriatic, Nitric ("Aqua Fortis") Sulphuric ("Oil of Vitriol"), are all highly corrode in their ac tion, unless largely diluted, and act with even greater rapidity when taken internally than when applied externally (see page 30) They are about as troublesome in this respect as concentrated AL kalies. When taken, the Acid should be neutral,^, as far as possible by giving some harmless Alkali. Lime-water is usually about as convenient as any thing else for the purpose. Common Soap, from the Alkali it contains, might be given.