The Home Medical Library Volume I Part 15

=CHILBLAINS AND MILD FROSTBITES.=--The effects of severe cold on the body are very similar to those of intense heat, though they are very much slower in making their appearance. After a person has frozen a finger or toe he may not notice much inconvenience for days, when suddenly violent inflammation may set in. The fingers, ears, nose, and toes are the members which suffer most frequently from the effects of cold. Similar symptoms of inflammation, described under burns, also result from cold, that is, redness and swelling of the skin, blisters with more severe and deeper inflammatory involvement, or, in case the parts are thoroughly frozen, local death and destruction of the tissues. But it is not essential that the body be exposed to the freezing temperature or be frozen at all, in order that some harm may result, for chilblains often follow when the temperature has not been lower than 40 F., or thereabouts.

The effect of cold is to contract the blood vessels, with the production of numbness, pallor, and tingling of the skin. When the cold no longer acts then the blood vessels dilate to more than their usual and normal state, and more or less inflammation results. The more sudden the return to warmth the greater the inflammatory sequel.

Chilblains represent the mildest morbid effect of cold on the body.

They exist as bluish-red swellings of the skin, usually on the feet or hands, but may attack the nose or ears, and are attended by burning, itching, and smarting. This condition is caused by dilatation of the vessels following exposure to cold. It is more apt to happen in young, anaemic women. Chilblains usually disappear during warm weather.

Scratching, friction, or the severity of the attack may lead to the appearance of blisters and sores. In severe cases the fingers and toes present a sausage-like appearance, owing to swelling.

=Treatment.=--Susceptible persons should wear thick, warm (not rough) stockings and warm gloves. The chilled members must never be suddenly warmed. Regular exercise and cold shower baths are good to strengthen the circulation, but the feet and hands must be washed in warm water only, and thoroughly dried. If sweating of these parts is a common occurrence, starch or zinc oxide should be dusted on freely night and morning. Cod-liver oil is an efficacious remedy in these cases; one teaspoonful of Peter Moller's pure oil three times daily after meals.

The affected parts are bathed twice daily in a solution of zinc acetate (one dram to one pint of water), and followed by the application, on soft linen or cotton, of zinc-oxide ointment containing two per cent of carbolic acid. If this is not curative, iodine ointment mixed with an equal quant.i.ty of lard may be tried.

Exposure to cold will immediately bring on a recurrence of the trouble. If the affection of the feet is severe the patient must rest in bed. If the parts become blistered and open sores appear, then the same treatment as for burns is indicated. Wash with a weak solution of corrosive sublimate (one tablet for surgical purposes in two quarts of warm water) and apply an ointment of boric acid and vaseline, equal parts, spread on soft, clean cotton or linen. Rest of the part and existence in a warm atmosphere will complete the cure.

=INGROWING TOE NAIL.=--This is a condition in which the flesh along the edges of the great toe nail becomes inflamed, owing either to overgrowth of the nail or to pressure of the soft parts against it.

Improper footgear is the most common cause, as shoes which are too narrow across the toes, or not long enough, or those with high heels which throw the toes forward so that they are compressed by the toe of the boot, especially in walking downhill.

A faulty mode of cutting the toe nails in a healthy foot may favor ingrowing toe nails. Toe nails should be cut straight across, and not trimmed away at the corners to follow the outline of the toes--as then the flesh crowds in at the corners of the nails, and when the nail pushes forward in its growth it presses into the flesh. Nails which have a very rounded surface are more apt to produce trouble, because then the edges are likely to grow down into the flesh. Inflammation in ingrowing toe nail usually arises along the outer edge of the nail.

The flesh here becomes red, tender, painful, and swollen so that it overlaps the nail. After a time "matter" or pus forms and finds its way under the nail, and the parts about it ulcerate, and "proud flesh" or excessive granulation tissue springs up and imbeds the edge of the nail. Wearing a shoe, or walking, becomes impossible. The condition may last for months, or even years, if not rightly treated.

=Treatment.=--Properly fitting footgear must be worn--broad at the toes with low heels and of sufficient length. If pus ("matter") forms, the cut edge should be raised up by pus.h.i.+ng in a little absorbent cotton under the nail every day. Hot poultices of flaxseed meal, or other material will relieve any special pain and inflammation. Soaking the foot frequently in hot water, and observing especial cleanliness, will aid recovery. Tannic acid, or some antiseptic powder like nosophen, should be dusted along the edge of the nail, and the flesh crowded away from the nail by pus.h.i.+ng in a little cotton with some tannic acid upon it.

If there is a raw surface about the border of the nail, powdered lead nitrate may be dusted upon it each morning for four or five days, till the ulcerated tissue shrinks away and the edge of the nail becomes visible. The toe should be covered with absorbent cotton and a bandage. As soon as the toe is really inflamed the case becomes surgical, and as such demands the care of a surgeon when one can be obtained.

=FAINTING.=

_First Aid Rule 1.--Remove impediments to respiration. Remove collar, loosen all waist bands and cords, unhook corset or cut the laces at person's back._

_Rule 2.--a.s.sist heart and brain with blood pressure. Put cus.h.i.+on under b.u.t.tocks, wind skirt close about legs, and raise feet in air.

Wait ten seconds._

_Rule 3.--Aid respiration. Put mild smelling salts under nose. Spatter cold water in face._

=SUFFOCATION FROM GAS IN WELLS, CISTERNS, OR MINES, OR FROM ILLUMINATING GAS.=

_First Aid Rule 1.--Remove quickly into pure air._

_Rule 2.--Resuscitate as if drowned. Open his mouth, grasp his tongue, pull it forward and keep it there. Let another a.s.sistant grasp the arms just below the elbows, and draw them steadily upward by the sides of the patient's head to the ground, the hands nearly meeting, which enlarges the capacity of the chest and induces inspiration. (See pp.

30 and 31.) While this is being done, let a third a.s.sistant take position astride the patient's hips with his elbows resting on his own knees, his hands extended ready for action. Next, let the a.s.sistant standing at the head turn down the patient's arms to the sides of his body, the a.s.sistant holding the tongue, changing hands if necessary to let the arms pa.s.s._

_Just before the patient's hands reach the ground, the man astride the body will grasp the body with his hands, the ball of the thumb resting on either side of the pit of the stomach, the fingers falling into the grooves between the short ribs. Now, using his knees as a pivot, he will, at the moment the patient's hands touch the ground, throw (not too suddenly) his whole weight forward on his hands, and at the same time squeeze the waist between them, as if he wished to force something in the chest upward out of the mouth; he will deepen the pressure while he slowly counts one, two, three, four (about five seconds), then suddenly lets go with a final push, which will send him back to his first position. This completes expiration. A child or a delicate person must be more gently handled._

_At the instant of letting go, the man at the head of the patient will again draw the arms steadily upward, to the sides of the patient's head, as before (the a.s.sistant holding the tongue again, changing hands if necessary to let the arms pa.s.s, holding them there while he slowly counts one, two, three, four (about five seconds))._

_Repeat these movements deliberately and perseveringly twelve or fifteen times in every minute, thus imitating the natural motions of breathing. Continue the artificial respiration from one to four hours, or until the patient breathes; and for a while after the appearance of returning life, carefully aid the first short gasps until deepened into full breaths._

_Keep the body warm with hot-water bottles and blanket._

_Rule 3.--Give oxygen to breathe from a cylinder, for two days, at short intervals, in the case of illuminating gas._

=FIT; CONVULSION.=

_First Aid Rule 1.--Aid breathing. Loosen collar, waist bands, and unhook corset, or cut the laces behind._

_Rule 2.--Protect from injury. Gently restrain from falling or rolling against furniture; lay flat on bed._

_Rule 3.--Protect tongue from being bitten. Open jaws and put between teeth rubber eraser tied to stout string, or rubber stopper tied to stout string._

_Rule 4.--Crush pearl of amyl nitrite in handkerchief, and hold close to patient's nose and mouth, till face is red and patient relaxes._

_Rule 5.--Let patient sleep after fit without rousing._

FOOTNOTES:

[9] Caution. Dangerous. Use only on physician's order.

[10] Caution. Dangerous. Use only on physician's order.

Part II

GERM DISEASES

BY

KENELM WINSLOW

CHAPTER I

=Contagious Diseases=

_Scarlet Fever--Symptoms and Treatment--Precautions Necessary--Measles--Communicating the Disease--Smallpox--Vaccination--How to Diagnose Chickenpox._

=ERUPTIVE CONTAGIOUS FEVERS= (_including Scarlet Fever, Measles, German Measles, Smallpox, and Chickenpox_).--These, with the exception of smallpox, attack children more commonly than adults. As they all begin with fever, and the characteristic rash does not appear for from one to four days after the beginning of the sickness, the diagnosis of these diseases must always be at the onset a matter of doubt. For this reason it is wise to keep any child with a fever isolated, even if the trouble seems to be due to "a cold" or to digestive disturbance, to avoid possible communication of the disorder to other children. While colds and indigestion are among the most frequent ailments of children, they must not be neglected, for measles begins as a bad cold, smallpox like the _grippe_, and scarlet fever with a sore throat or tonsilitis, and vomiting.

By isolation is meant that the sick child should stay in a room by himself, and the doors should be kept closed and no children should enter, nor should any objects in the room be removed to other parts of the house after the beginning of its occupation by the patient.

The services of a physician are particularly desirable in all these diseases, in order that an early diagnosis be made and measures be taken to protect the family, neighbors, and community from contagion.

The failure of parents or guardians to secure medical aid for children is regarded by the law as criminal neglect, and is subject to punishment. Boards of health require the reporting of all contagious diseases as soon as their presence is known, and failure to comply with their rules also renders the offender liable to fine or imprisonment in most places.