If the wound is at once well wiped out, and a stick of solid nitrate of silver (lunar caustic) rapidly applied to the entire surface of the wound, little danger is to be apprehended. Poultices and warm fomentations should be applied to the injury to hasten the sloughing away of the part whose vitality has been intentionally destroyed.

Any dog, after having bitten a person, is apt, under a mistaken belief, to be at once killed. This should not be done. There is no more danger from a dog-bite, unless the dog is suffering from the disease called rabies or is "mad," than from any other lacerated wound. The suspected animal should be at once placed in confinement and watched, under proper safeguards, for the appearance of any symptoms that indicate rabies.

Should no pronounced symptoms indicate this disease in the dog, a great deal of unnecessary mental distress and worry can be saved both on the part of the person bitten and his friends.

363. Injuries to the Blood-vessels. It is very important to know the difference between the bleeding from an artery and that from a vein.

If an artery bleeds, the blood leaps in spurts, and is of a bright scarlet color.

If a vein bleeds, the blood flows in a steady stream, and is of a dark purple color.

If the capillaries are injured the blood merely oozes.

Bleeding from an artery is a dangerous matter in proportion to the size of the vessel, and life itself may be speedily lost. Hemorrhage from a vein or from the capillaries is rarely troublesome, and is ordinarily easily checked, aided, if need be, by hot water, deep pressure, the application of some form of iron styptic, or even powdered alum. When an artery is bleeding, always remember to make deep pressure between the wound and the heart. In all such cases send at once for the doctor.



Do not be afraid to act at once. A resolute grip in the right place with firm fingers will do well enough, until a twisted handkerchief, stout cord, shoestring, suspender, or an improvised tourniquet[53] is ready to take its place. If the flow of blood does not stop, change the pressure until the right spot is found.

Sometimes it will do to seize a handful of dry earth and crowd it down into the bleeding wound, with a firm pressure. Strips of an old handkerchief, underclothing, or cotton wadding may also be used as a compress, provided pressure is not neglected.

In the after-treatment it is of great importance that the wound and the dressing should be kept free from bacteria by keeping everything surgically clean.

364. Where and how to Apply Pressure. The principal places in which to apply pressure when arteries are injured and bleeding should always be kept in mind.

Experiment 192. How to tie a square knot. If the student would render efficient help in accidents and emergencies, to say nothing of service on scores of other occasions, he must learn how to tie a square or "reef" knot. This knot is secure and does not slip as does the "granny" knot. The square knot is the one used by surgeons in ligating vessels and securing bandages. Unless one knew the difference, the insecure "granny" knot might be substituted.



A square knot is tied by holding an end of a bandage or cord in each hand, and then passing the end in the right hand over the one in the left and tying; the end now in the left hand is passed over the one in the right and again tied.

If in the finger, grasp it with the thumb and forefinger, and pinch it firmly on each side; if in the hand, press on the bleeding spot, or press with the thumb just above and in front of the wrist.

For injuries below the elbow, grasp the upper part of the arm with the hands, and squeeze hard. The main artery runs in the middle line of the bend of the elbow. Tie the knotted cord here, and bend the forearm so as to press hard against the knot.

For the upper arm, press with the fingers against the bone on the inner side, and just on the edge of the swell of the biceps muscle. Now we are ready for the knotted cord. Take a stout stick of wood, about a foot long, and twist the cord hard with it, bringing the knot firmly over the artery.

For the foot or leg, pressure as before, in the hollow behind the knee, just above the calf of the leg. Bend the thigh towards the abdomen and bring the leg up against the thigh, with the knot in the bend of the knee.

365. Bleeding from the Stomach and Lungs. Blood that comes from the lungs is bright red, frothy, or "soapy." There is rarely much; it usually follows coughing, feels warm, and has a salty taste. This is a grave symptom. Perfect rest on the back in bed and quiet must be insisted upon. Bits of ice should be eaten freely. Loosen the clothing, keep the shoulders well raised, and the body in a reclining position and absolutely at rest. Do not give alcoholic drinks.

Blood from the stomach is not frothy, has a sour taste, and is usually dark colored, looking somewhat like coffee grounds. It is more in quantity than from the lungs, and is apt to be mixed with food. Employ the same treatment, except that the person should be kept flat on the back.

366. Bleeding from the Nose. This is the most frequent and the least dangerous of the various forms of bleeding. Let the patient sit upright; leaning forward with the head low only increases the hemorrhage. Raise the arm on the bleeding side; do not blow the nose. Wring two towels out of cold water; wrap one around the neck and the other properly folded over the forehead and upper part of the nose.

Add a teaspoonful of powdered alum to a cup of water, and snuff it up from the hand. If necessary, soak in alum water a piece of absorbent cotton, which has been wound around the pointed end of a pencil or penholder; plug the nostril by pushing it up with a twisting motion until firmly lodged.

367. Burns or Scalds. Burns or scalds are dangerous in proportion to their extent and depth. A child may have one of his fingers burned off with less danger to life than an extensive scald of his back and legs. A deep or extensive burn or scald should always have prompt medical attendance.

In burns by acids, bathe the parts with an alkaline fluid, as diluted ammonia, or strong soda in solution, and afterwards dress the burn.

In burns caused by lime, caustic potash, and other alkalies, soak the parts with vinegar diluted with water; lemon juice, or any other diluted acid.

Remove the clothing with the greatest care. Do not pull, but carefully cut and coax the clothes away from the burned places. Save the skin unbroken if possible, taking care not to break the blisters. The secret of treatment is to prevent friction, and to keep out the air. If the burn is slight, put on strips of soft linen soaked in a strong solution of baking-soda and water, one heaping table spoonful to a cupful of water. This is especially good for scalds.



Carron oil is one of the best applications. It is simply half linseed-oil and half lime-water shaken together. A few tablespoonfuls of carbolic acid solution to one pint may be added to this mixture to help deaden the pain. Soak strips of old linen or absorbent cotton in this time-honored remedy, and gently apply.

If carbolized or even plain vaseline is at hand, spread it freely on strips of old linen, and cover well the burnt parts, keeping out the air with other strips carefully laid on. Simple cold water is better than flour, starch, toilet powder, cotton batting, and other things which are apt to stick, and make an after-examination very painful.



368. Frost Bites. The ears, toes, nose, and fingers are occasionally frozen, or frost-bitten. No warm air, warm water, or fire should be allowed near the frozen parts until the natural temperature is nearly restored. Rub the frozen part vigorously with snow or snow-water in a cold room. Continue this until a burning, tingling pain is felt, when all active treatment should cease.

Pain shows that warmth and circulation are beginning to return. The after effects of a frost bite are precisely like those of a burn, and require similar treatment. Poultices made from scraped raw potatoes afford much comfort for an after treatment.

369. Catching the Clothing on Fire. When the clothing catches fire, throw the person down on the ground or floor, as the flames will tend less to rise toward the mouth and nostrils. Then without a moment's delay, roll the person in a carpet or hearth-rug, so as to stifle the flames, leaving only the head out for breathing.

If no carpet or rug can be had, then take off your coat, shawl, or cloak and use it instead. Keep the flame as much as possible from the face, so as to prevent the entrance of the hot air into the lungs. This can be done by beginning at the neck and shoulders with the wrapping.

370. Foreign Bodies in the Throat. Bits of food or other small objects sometimes get lodged in the throat, and are easily extracted by the forefinger, by sharp slaps on the back, or expelled by vomiting. If it is a sliver from a toothpick, match, or fishbone, it is no easy matter to remove it; for it generally sticks into the lining of the passage. If the object has actually passed into the windpipe, and is followed by sudden fits of spasmodic coughing, with a dusky hue to the face and fingers, surgical help must be called without delay.

If a foreign body, like coins, pencils, keys, fruit-stones, etc., is swallowed, it is not wise to give a physic. Give plenty of hard-boiled eggs, cheese, and crackers, so that the intruding substance maybe enfolded in a mass of solid food and allowed to pass off in the natural way.

371. Foreign Bodies in the Nose. Children are apt to push beans, peas, fruit-stones, buttons, and other small objects, into the nose. Sometimes we can get the child to help by blowing the nose hard. At other times, a sharp blow between the shoulders will cause the substance to fall out. If it is a pea or bean, which is apt to swell with the warmth and moisture, call in medical help at once.

372. Foreign Bodies in the Ear. It is a much more difficult matter to get foreign bodies out of the ear than from the nose. Syringe in a little warm water, which will often wash out the substance. If live insects get into the ear, drop in a little sweet oil, melted vaseline, salt and water, or even warm molasses.

If the tip of the ear is pulled up gently, the liquid will flow in more readily. If a light is held close to the outside ear, the insect may be coaxed to crawl out towards the outer opening of the ear, being attracted by the bright flame.

373. Foreign Bodies in the Eye. Cinders, particles of dust, and other small substances, often get into the eye, and cause much pain. It will only make bad matters worse to rub the eye. Often the copious flow of tears will wash the substance away. It is sometimes seen, and removed simply by the twisted corner of a handkerchief carefully used. If it is not removed, or even found, in this way, the upper lid must be turned back.



This is done usually as follows: Seize the lashes between the thumb and forefinger, and draw the edge of the lid away from the eyeball. Now, telling the patient to look down, press a slender lead-pencil or penholder against the lid, parallel to and above the edge, and then pull the edge up, and turn it over the pencil by means of the lashes.

The eye is now readily examined, and usually the foreign body is easily seen and removed. Do not increase the trouble by rubbing the eye after you fail, but get at once skilled help. After the substance has been removed, bathe the eye for a time with hot water.

If lime gets into the eye, it may do a great amount of mischief, and generally requires medical advice, or permanent injury will result. Until such advice can be had, bathe the injured parts freely with a weak solution of vinegar and hot water.

374. Broken Bones. Loss of power, pain, and swelling are symptoms of a broken bone that may be easily recognized. Broken limbs should always be handled with great care and tenderness. If the accident happens in the woods, the limb should be bound with handkerchiefs, suspenders, or strips of clothing, to a piece of board, pasteboard, or bark, padded with moss or grass, which will do well enough for a temporary splint. Always put a broken arm into a sling after the splints are on.



Never move the injured person until the limb is made safe from further injuries by putting on temporary splints. If you do not need to move the person, keep the limb in a natural, easy position, until the doctor comes.

Remember that this treatment for broken bones is only to enable the patient to be moved without further injury. A surgeon is needed at once to set the broken bone.



375. Fainting. A fainting person should be laid flat at once. Give plenty of fresh air, and dash cold water, if necessary, on the head and neck. Loosen all tight clothing. Smelling-salts may be held to the nose, to excite the nerves of sensation.

376. Epileptic and Hysterical Fits, Convulsions of Children. Sufferers from "fits" are more or less common. In epilepsy, the sufferer falls with a peculiar cry; a loss of consciousness, a moment of rigidity, and violent convulsions follow. There is foaming at the mouth, the eyes are rolled up, and the tongue or lips are often bitten. When the fit is over the patient remains in a dazed, stupid state for some time. It is a mistake to struggle with such patients, or to hold them down and keep them quiet. It does more harm than good.

See that the person does not injure himself; crowd a pad made from a folded handkerchief or towel between the teeth, to prevent biting of the lips or tongue. Do not try to make the sufferer swallow any drink. Unfasten the clothes, especially about the neck and chest. Persons who are subject to such fits should rarely go out alone, and never into crowded or excited gatherings of any kind.

Hysterical fits almost always occur in young women. Such patients never bite their tongue nor hurt themselves. Placing a towel wrung out in cold water across the face, or dashing a little cold water on the face or neck, will usually cut short the fit, speaking firmly to the patient at the same time. Never sympathize too much with such patients; it will only make them a great deal worse.

377. Asphyxia. Asphyxia is from the Greek, and means an "absence of pulse." This states a fact, but not the cause. The word is now commonly used to mean suspended animation. When for any reason the proper supply of oxygen is cut off, the tissues rapidly load up with carbon dioxid. The blood turns dark, and does not circulate. The healthy red or pink look of the lips and finger-nails becomes a dusky purple. The person is suffering from a lack of oxygen; that is, from asphyxia, or suffocation. It is evident there can be several varieties of asphyxia, as in apparent drowning, strangulation and hanging, inhalation of gases, etc.

The first and essential thing to do is to give fresh air. Remove the person to the open air and place him on his back. Remove tight clothing about the throat and waist, dash on cold water, give a few drops of ammonia in hot water or hot ginger tea. Friction applied to the limbs should be kept up. If necessary, use artificial respiration by the Sylvester method (sec. 380).

The chief dangers from poisoning by noxious gases come from the fumes of burning coal in the furnace, stove, or range; from "blowing out" gas, turning it down, and having it blown out by a draught; from the foul air often found in old wells; from the fumes of charcoal and the foul air of mines.

378. Apparent Drowning. Remove all tight clothing from the neck, chest, and waist. Sweep the forefinger, covered with a handkerchief or towel, round the mouth, to free it from froth and mucus. Turn the body on the face, raising it a little, with the hands under the hips, to allow any water to run out from the air passages. Take only a moment for this.

Lay the person flat upon the back, with a folded coat, or pad of any kind, to keep the shoulders raised a little. Remove all the wet, clinging clothing that is convenient. If in a room or sheltered place, strip the body, and wrap it in blankets, overcoats, etc. If at hand, use bottles of hot water, hot flats, or bags of hot sand round the limbs and feet. Watch the tongue: it generally tends to slip back, and to shut off the air from the glottis. Wrap a coarse towel round the tip of the tongue, and keep it well pulled forward.

The main thing to do is to keep up artificial respiration until the natural breathing comes, or all hope is lost. This is the simplest way to do it: The person lies on the back; let some one kneel behind the head. Grasp both arms near the elbows, and sweep them upward above the head until they nearly touch. Make a firm pull for a moment. This tends to fill the lungs with air by drawing the ribs up, and making the chest cavity larger. Now return the arms to the sides of the body until they press hard against the ribs. This tends to force out the air. This makes artificially a complete act of respiration. Repeat this act about fifteen times every minute.



All this may be kept up for several hours. The first sign of recovery is often seen in the slight pinkish tinge of the lips or finger-nails. That the pulse cannot be felt at the wrist is of little value in itself as a sign of death. Life may be present when only the most experienced ear can detect the faintest heart-beat.

When a person can breathe, even a little, he can swallow. Hold smelling-salts or hartshorn to the nose. Put one teaspoonful of the aromatic spirits of ammonia, or even of ammonia water, into a half-glass of hot water, and give a few teaspoonfuls of this mixture every few minutes. Meanwhile do not fail to keep up artificial warmth in the most vigorous manner.

379. Methods of Artificial Respiration. There are several well-established methods of artificial respiration. The two known as the Sylvester and the Marshall Hall methods are generally accepted as efficient and practical.



380. The Sylvester Method. The water and mucus are supposed to have been removed from the interior of the body by the means above described (sec. 378).

The patient is to be placed on his back, with a roll made of a coat or a shawl under the shoulders; the tongue should then be drawn forward and retained by a handkerchief which is placed across the extended organ and carried under the chin, then crossed and tied at the back of the neck. An elastic band or small rubber tube or a suspender may be used for the same purpose.

The attendant should kneel at the head and grasp the elbows of the patient and draw them upward until the hands are carried above the head and kept in this position until one, two, three, can be slowly counted. This movement elevates the ribs, expands the chest, and creates a vacuum in the lungs into which the air rushes, or in other words, the movement produces inspiration. The elbows are then slowly carried downward, placed by the side, and pressed inward against the chest, thereby diminishing the size of the latter and producing expiration.

These movements should be repeated about fifteen times each minute for at least two hours, provided no signs of animation show themselves.

381. The Marshall Hall Method. The patient should be placed face downwards, the head resting on the forearm with a roll or pillow placed under the chest; he should then be turned on his side, an assistant supporting the head and keeping the mouth open; after an interval of two or three seconds, the patient should again be placed face downward and allowed to remain in this position the same length of time. This operation should be repeated fifteen or sixteen times each minute, and continued (unless the patient recovers) for at least two hours.



If, after using one of the above methods, evidence of recovery appears, such as an occasional gasp or muscular movement, the efforts to produce artificial respiration must not be discontinued, but kept up until respiration is fully established. All wet clothing should then be removed, the patient rubbed dry, and if possible placed in bed, where warmth and warm drinks can be properly administered. A small amount of nourishment, in the form of hot milk or beef tea, should be given, and the patient kept quiet for two or three days.



382. Sunstroke or Heatstroke. This serious accident, so far-reaching oftentimes in its result, is due to an unnatural elevation of the bodily temperature by exposure to the direct rays of the sun, or from the extreme heat of close and confined rooms, as in the cook-rooms and laundries of hotel basements, from overheated workshops, etc.

There is sudden loss of consciousness, with deep, labored breathing, an intense burning heat of the skin, and a marked absence of sweat. The main thing is to lower the temperature. Strip off the clothing; apply chopped ice, wrapped in flannel to the head. Rub ice over the chest, and place pieces under the armpits and at the sides. If there is no ice, use sheets or cloths wet with cold water. The body may be stripped, and sprinkled with ice-water from a common watering-pot.

If the skin is cold, moist, or clammy, the trouble is due to heat exhaustion. Give plenty of fresh air, but apply no cold to the body. Apply heat, and give hot drinks, like hot ginger tea. Sunstroke or heatstroke is a dangerous affliction. It is often followed by serious and permanent results. Persons who have once suffered in this way should carefully avoid any risk in the future.



Chapter XIV.

In Sickness and in Health.



383. Arrangement of the Sick-room. This room, if possible, should be on the quiet and sunny side of the house. Pure, fresh air, sunshine, and freedom from noise and odor are almost indispensable. A fireplace as a means of ventilation is invaluable. The bed should be so placed that the air may get to it on all sides and the nurse move easily around it. Screens should be placed, if necessary, so as to exclude superfluous light and draughts.

The sick-room should be kept free from all odors which affect the sick unpleasantly, as perfumery, highly scented soaps, and certain flowers. Remove all useless ornaments and articles likely to collect dust, as unnecessary pieces of furniture and heavy draperies. A clean floor, with a few rugs to deaden the footsteps, is much better than a woolen carpet. Rocking-chairs should be banished from the sick-room, as they are almost sure to disturb the sick.

A daily supply of fresh flowers tends to brighten the room. Keep the medicines close at hand, but all poisonous drugs should be kept carefully by themselves and ordinarily under lock and key. A small table should be placed at the bedside, and on it the bell, food tray, flowers and other small things which promote the comfort of the patient.

The nurse should not sleep with the patient. Sofas and couches are not commonly comfortable enough to secure needed rest. A cot bed is at once convenient and inexpensive, and can be readily folded and put out of sight in the daytime. It can also be used by the patient occasionally, especially during convalescence.

384. Ventilation of the Sick-room. Proper ventilation is most essential to the sick-room, but little provision is ordinarily made for so important a matter. It is seldom that one of the windows cannot be let down an inch or more at the top, a screen being arranged to avoid any draught on the patient. Remove all odors by ventilation and not by spraying perfumery, or burning pastilles, which merely conceal offensive odors without purifying the air. During cold weather and in certain diseases, the patient may be covered entirely with blankets and the windows opened wide for a few minutes.

Avoid ventilation by means of doors, for the stale air of the house, kitchen smells, and noises made by the occupants of the house, are apt to reach the sick-room. The entire air of the room should be changed at least two or three times a day, in addition to the introduction of a constant supply of fresh air in small quantities.

385. Hints for the Sick-room. Always strive to look cheerful and pleasant before the patient. Whatever may happen, do not appear to be annoyed, discouraged, or despondent. Do your best to keep up the courage of sick persons under all circumstances. In all things keep in constant mind the comfort and ease of the patient.

Do not worry the sick with unnecessary questions, idle talk, or silly gossip. It is cruel to whisper in the sick-room, for patients are always annoyed by it. They are usually suspicious that something is wrong and generally imagine that their condition has changed for the worse.

Symptoms of the disease should never be discussed before the patient, especially if he is thought to be asleep. He may be only dozing, and any such talk would then be gross cruelty. Loud talking must, of course, be avoided. The directions of the physician must be rigidly carried out in regard to visitors in the sick-room. This is always a matter of foremost importance, for an hour or even a night of needed sleep and rest may be lost from the untimely call of some thoughtless visitor. A competent nurse, who has good sense and tact, should be able to relieve the family of any embarrassment under such circumstances.

Do not ever allow a kerosene light with the flame turned down to remain in the sick-room. Use the lamp with the flame carefully shaded, or in an adjoining room, or better still, use a sperm candle for a night light.

Keep, so far as possible, the various bottles of medicine, spoons, glasses, and so on in an adjoining room, rather than to make a formidable array of them on a bureau or table near the sick-bed. A few simple things, as an orange, a tiny bouquet, one or two playthings, or even a pretty book, may well take their place.

The ideal bed is single, made of iron or brass, and provided with woven wire springs and a hair mattress. Feather-beds are always objectionable in the sick-room for many and obvious reasons. The proper making of a sick-bed, with the forethought and skill demanded in certain diseases, is of great importance and an art learned only after long experience. The same principle obtains in all that concerns the lifting and the moving of the sick.

Sick people take great comfort in the use of fresh linen and fresh pillows. Two sets should be used, letting one be aired while the other is in use. In making changes the fresh linen should be thoroughly aired and warmed and everything in readiness before the patient is disturbed.

386. Rules for Sick-room. Do not deceive sick people. Tell what is proper or safe to be told, promptly and plainly. If a physician is employed, carry out his orders to the very letter, as long as he visits you. Make on a slip of paper a note of his directions. Make a brief record of exactly what to do, the precise time of giving medicines, etc. This should always be done in serious cases, and by night watchers. Then there is no guesswork. You have the record before you for easy reference. All such things are valuable helps to the doctor.

Whatever must be said in the sick-room, say it openly and aloud. How often a sudden turn in bed, or a quick glance of inquiry, shows that whispering is doing harm! If the patient is in his right mind, answer his questions plainly and squarely. It may not be best to tell all the truth, but nothing is gained in trying to avoid a straightforward reply.

Noises that are liable to disturb the patient, in other parts of the house than the sick-room, should be avoided. Sounds of a startling character, especially those not easily explained, as the rattling or slamming of distant blinds and doors, are always irritating to the sick.

Always attract the attention of a patient before addressing him, otherwise he may be startled and a nervous spell be induced. The same hint applies equally to leaning or sitting upon the sick-bed, or running against furniture in moving about the sick-room.

387. Rest of Mind and Body. The great importance of rest for the sick is not so generally recognized as its value warrants. If it is worry and not work that breaks down the mental and physical health of the well, how much more important is it that the minds and bodies of the sick should be kept at rest, free from worry and excitement! Hence the skilled nurse does her best to aid in restoring the sick to a condition of health by securing for her patient complete rest both of mind and body. To this end, she skillfully removes all minor causes of alarm, irritation, or worry. There are numberless ways in which this may be done of which space does not allow even mention. Details apparently trifling, as noiseless shoes, quietness, wearing garments that do not rustle, use of small pillows of different sizes, and countless other small things that make up the refinement of modern nursing, play an important part in building up the impaired tissues of the sick.

388. Care of Infectious and Contagious Diseases. There are certain diseases which are known to be infectious and can be communicated from one person to another, either by direct contact, through the medium of the atmosphere, or otherwise.

Of the more prevalent infectious and contagious diseases are scarlet fever, diphtheria, erysipelas, measles, and typhoid fever.

Considerations of health demand that a person suffering from any one of these diseases should be thoroughly isolated from all other members of the family. All that has been stated in regard to general nursing in previous sections of this chapter, applies, of course, to nursing infectious and contagious diseases. In addition to these certain special directions must be always kept in mind.

Upon the nurse, or the person having the immediate charge of the patient, rests the responsibility of preventing the spread of infectious diseases. The importance must be fully understood of carrying out in every detail the measures calculated to check the spread or compass the destruction of the germs of disease.

389. Hints on Nursing Infectious and Contagious Diseases. Strip the room of superfluous rugs, carpets, furniture, etc. Isolate two rooms, if possible, and have these, if convenient, at the top of the house. Tack sheets, wet in some proper disinfectant, to the outer frame of the sick-room door. Boil these sheets every third day. In case of diseases to which young folks are very susceptible, send the children away, if possible, to other houses where there are no children.

Most scrupulous care should be taken in regard to cleanliness and neatness in every detail. Old pieces of linen, cheese-cloth, paper napkins, should be used wherever convenient or necessary and then at once burnt. All soiled clothing that cannot well be burnt should be put to soak at once in disinfectants, and afterward boiled apart from the family wash. Dishes and all utensils should be kept scrupulously clean by frequent boiling. For the bed and person old and worn articles of clothing that can be destroyed should be worn so far as possible.

During convalescence, or when ready to leave isolation, the patient should be thoroughly bathed in water properly disinfected, the hair and nails especially being carefully treated.

Many details of the after treatment depend upon the special disease, as the rubbing of the body with carbolized vaseline after scarlet fever, the care of the eyes after measles, and other particulars of which space does not admit mention here.



Poisons and Their Antidotes.

390. Poisons. A poison is a substance which, if taken into the system in sufficient amounts, will cause serious trouble or death. For convenience poisons may be divided into two classes, irritants and narcotics.

The effects of irritant poisons are evident immediately after being taken. They burn and corrode the skin or membrane or other parts with which they come in contact. There are burning pains in the mouth, throat, stomach, and abdomen, with nausea and vomiting. A certain amount of faintness and shock is also present.

With narcotic poisoning, the symptoms come on more slowly. After a time there is drowsiness, which gradually increases until there is a profound sleep or stupor, from which the patient can be aroused only with great difficulty. There are some substances which possess both the irritant and narcotic properties and in which the symptoms are of a mixed character.

391. Treatment of Poisoning. An antidote is a substance which will either combine with a poison to render it harmless, or which will have a directly opposite effect upon the body, thus neutralizing the effect of the poison. Hence in treatment of poisoning the first thing to do, if you know the special poison, is to give its antidote at once.

If the poison is unknown, and there is any delay in obtaining the antidote, the first thing to do is to remove the poison from the stomach. Therefore cause vomiting as quickly as possible. This may be done by an emetic given as follows: Stir a tablespoonful of mustard or of common salt in a glass of warm water and make the patient swallow the whole. It will usually be vomited in a few moments. If mustard or salt is not at hand, compel the patient to drink lukewarm water very freely until vomiting occurs.

Vomiting may be hastened by thrusting the forefinger down the throat. Two teaspoonfuls of the syrup of ipecac, or a heaping teaspoonful of powdered ipecac taken in a cup of warm water, make an efficient emetic, especially if followed with large amounts of warm water.

It is to be remembered that in some poisons, as certain acids and alkalies, no emetic should be given. Again, for certain poisons (except in case of arsenic) causing local irritation, but which also affect the system at large, no emetic should be given.

392. Reference Table of Common Poisons; Prominent Symptoms; Antidotes and Treatment. The common poisons with their leading symptoms, treatment, and antidotes, may be conveniently arranged for easy reference in the form of a table.

It is to be remembered, of course, that a complete mastery of the table of poisons, as set forth on the two following pages, is really a physician's business. At the same time, no one of fair education should neglect to learn a few of the essential things to do in accidental or intentional poisoning.

A Table of the More Common Poisons,

With their prominent symptoms, antidotes, and treatment.

Poison Prominent Symptoms Antidotes and Treatment

Strong Acids:

Muriatic, Burning sensation in No emetic Saleratus; Nitric, mouth, throat, and chalk; soap; plaster from Sulphuric (vitriol), stomach; blisters the wall; lime; magnesia; Oxalic. about mouth; vomiting; baking soda (3 or 4 great weakness teaspoonfuls in a glass of water).

Alkalies:

Caustic potash and Burning sensation in No emetic Olive oil soda, the parts; severe pain freely; lemon juice, vinegar; Ammonia, in stomach; vomiting; melted butter and vaseline; Lye, difficulty in thick cream. Pearlash, swallowing; cold skin; Saltpeter. weak pulse.

Arsenic:

Paris green, Intense pains in Vomit patient repeatedly, Rough on rats, stomach and bowels; give hydrated oxide of iron White arsenic, thirst; vomiting, with magnesia, usually kept Fowler's solution, perhaps with blood; by druggists for emergencies; Scheele's green. cold and clammy skin. follow with strong solution of common salt and water.

Other Metallic Poisons:

Blue vitriol, Symptoms in general, Emetic with lead; none with Copperas, same as in arsenical copper and iron; white of Green vitriol, poisoning. With lead eggs in abundance with Sugar of lead, and mercury there may copper; with iron and lead Corrosive be a metallic taste in give epsom salts freely; sublimate, the mouth. afterwards, oils, flour, and Bedbug poison. water. No emetic with mercury; raw eggs; milk, or flour, and water.

Phosphorus from

Matches, rat Pain in the stomach; Cause vomiting. poisons,etc. vomiting; purging; Strong soapsuds; general collapse. magnesia in water. Never give oils.

Opium: Morphine, Sleepiness; dullness; Cause vomiting. Keep Laudanum, stupor; "pin-hole" patient awake by any means, Paregoric, pupils; slow especially by vigorous Dover's powder, breathing; profuse walking; give strong coffee Soothing syrups, sweat. freely; dash cold water on Cholera and diarrhoea face and chest. mixtures.

Carbolic Acid: Creasote. Severe pain in abdomen; No emetic. Milk or odor of carbolic acid, flour and water; white of mucous membrane in eggs. around mouth white and benumbed; cold and clammy skin.

Aconite: Wolfsbane Numbness everywhere, Vomit patient freely. Monkshood great weakness; cold Stimulating drinks. sweat.

Belladonna Deadly Nightshade Eyes bright, with pupil Vomit patient freely. Atropia enlarged; dry mouth and throat.

Various Vegetable Poisons Wild parsley, Stupor, nausea, great Cause brisk vomiting. Indian tobacco, weakness and other Stimulating drinks. Toadstools, symptoms according to Tobacco plant, the poison. Hemlock, Berries of the mountain ash, Bitter sweet etc.

393. Practical Points about Poisons. Poisons should never be kept in the same place with medicines or other preparations used in the household. They should always be put in some secure place under lock and key. Never use internally or externally any part of the contents of any package or bottle unless its exact nature is known. If there is the least doubt about the substance, do not assume the least risk, but destroy it at once. Many times the unknown contents of some bottle or package has been carelessly taken and found to be poison.

Careless and stupid people often take, by mistake, with serious, and often fatal, results, poisonous doses of carbolic acid, bed-bug poison, horse-liniment, oxalic acid, and other poisons. A safe rule is to keep all bottles and boxes containing poisonous substances securely bottled or packed, and carefully labeled with the word POISON plainly written in large letters across the label. Fasten the cork of a bottle containing poison to the bottle itself with copper or iron wire twisted into a knot at the top. This is an effective means of preventing any mistakes, especially in the night.

This subject of poisons assumes nowadays great importance, as it is a common custom to keep about stables, workshops, bathrooms, and living rooms generally a more or less formidable array of germicides, disinfectants, horse-liniments, insect-poisons, and other preparations of a similar character. For the most part they contain poisonous ingredients.



Bacteria.

394. Nature Of Bacteria. The word bacteria is the name applied to very low forms of plant life of microscopic size. Thus, if hay be soaked in water for some time, and a few drops of the liquid are examined under a high power of the microscope, the water is found to be swarming with various forms of living vegetable organisms, or bacteria. These microscopic plants belong to the great fungus division, and consist of many varieties, which may be roughly divided into groups, according as they are spherical, rod-like, spiral, or otherwise in shape.

Each plant consists of a mass of protoplasm surrounded by an ill-defined cell wall. The bacteria vary cably in size. Some of the rod-shaped varieties are from 1/12,000 to 1/8,000 of an inch in length, and average about 1/50,000 of an inch in diameter. It has been calculated that a space of one cubic millimeter would contain 250,000,000 of these minute organisms, and that they would not weigh more than a milligram.

. D, bacteria found in pus (tendency to grow in the form of chains). [Magnified about 500 diameters.] ]

Bacteria are propagated in a very simple manner. The parent cell divides into two; these two into two others, and so on. The rapidity with which these organisms multiply under favorable conditions, makes them, in some cases, most dangerous enemies. It has been calculated that if all of the organisms survived, one bacterium would lead to the production of several billions of others in twenty-four hours.

395. The Struggle of Bacteria for Existence. Like all kinds of living things, many species of bacteria are destroyed if exposed to boiling water or steam, but seem able to endure prolonged cold, far below the freezing-point. Thus ice from ponds and rivers may contain numerous germs which resume their activity when the ice is melted. Typhoid fever germs have been known to take an active and vigorous growth after they have been kept for weeks exposed in ice to a temperature below zero.

The bacteria of consumption (bacillus tuberculosis) may retain their vitality for months, and then the dried expectoration of the invalids may become a source of danger to those who inhale air laden with such impurities (sec. 220 and Fig. 94).

Like other living organisms, bacteria need warmth, moisture, and some chemical compound which answers for food, in order to maintain the phenomena of life. Some species grow only in contact with air, others need no more oxygen than they can obtain in the fluid or semi-fluid which they inhabit.

396. Importance of Bacteria in Nature. We might well ask why the myriads of bacteria do not devastate the earth with their marvelous rapidity of propagation. So indeed they might, were it not for the winds, rains, melting snow and ice which scatter them far and wide, and destroy them.

Again, as in countless other species of living organisms, bacteria are subject to the relentless law which allows only the fittest to survive. The bacteria of higher and more complex types devour those of a lower type. Myriads perish in the digestive tract of man and other animals. The excreta of some species of bacteria act as poison to destroy other species.

It is true from the strictest scientific point of view that all living things literally return to the dust whence they came. While living they borrow a few elementary substances and arrange them in new combinations, by aid of the energy given them by the sun, and after a time die and leave behind all they had borrowed both of energy and matter.

Countless myriads of bacteria are silently at work changing dead animal and vegetable matter into useful substances. In brief, bacteria prepare food for all the rest of the world. Were they all destroyed, life upon the earth would be impossible, for the elements necessary to maintain it would be embalmed in the bodies of the dead.

397. Action of Bacteria. In certain well-known processes bacteria have the power of bringing about decomposition of various kinds. Thus a highly organized fungus, like the yeast plant, growing in the presence of sugar, has the power of breaking down this complex body into simpler ones, viz., alcohol and carbon dioxid.

In the same way, various forms of bacteria have the power of breaking down complex bodies in their immediate neighborhood, the products depending upon the substance, the kind of bacteria, and the conditions under which they act. Thus the bacteria lactis act upon the milk sugar present in milk, and convert it into lactic acid, thus bringing about the souring of milk.



Now, while most species of bacteria are harmless, some are the cause of sickness and death when they gain admittance to the body under certain conditions. These disease-producing bacteria (known as pathogenic), when established in the blood and tissues of the body, bring about important chemical changes, depending upon the species of bacteria, and also produce a particular form of disease. The production of certain diseases by the agency of bacteria has now been proved beyond all doubt. In yellow fever, erysipelas, diphtheria, typhoid fever, consumption and other diseases, the connection has been definitely established.

The evil results these germs of disease produce vary greatly in kind and severity. Thus the bacteria of Asiatic cholera and diphtheria may destroy life in a few hours, while those of consumption may take years to produce a fatal result. Again, the bacteria may attack some particular organ, or group of organs, and produce mostly local symptoms. Thus in a boil there is painful swelling due to the local effect of the bacteria, with slight general disturbance.

398. The Battle against Bacteria. When we reflect upon the terrible ravages made by infectious diseases, and all their attendant evils for these many years, we can the better appreciate the work done of late years by tireless scientists in their efforts to modify the activity of disease-producing bacteria. It is now possible to cultivate certain pathogenic bacteria, and by modifying the conditions under which they are grown, to destroy their violence.

In brief, science has taught us, within certain limitations, how to change the virulent germs of a few diseases into harmless microbes.

399. Alcoholic Fermentation and Bacteria. Men of the lowest, as well as of the highest, type of civilization have always known that when the sugary juice of any fruit is left to itself for a time, at a moderately warm temperature, a change takes place under certain conditions, and the result is a liquid which, when drank, produces a pronounced effect upon the body. In brief, man has long known how to make for himself alcoholic beverages, by means of which he may become intoxicated with their poisonous ingredients.

Whether it is a degraded South Sea Islander making a crude intoxicant from a sugary plant, a Japanese preparing his favorite alcoholic beverage from the fermentation of rice by means of a fungus plant grown for the purpose, a farmer of this country making cider from fermenting apple juice, or a French expert manufacturing costly champagne by a complicated process, the outcome and the intent are one and the same. The essential thing is to produce an alcoholic beverage which will have a marked physiological effect. This effect is poisonous, and is due solely to the alcoholic ingredient, without which man would have little or no use for the otherwise harmless liquid.

While the practical process of making some form of alcoholic beverage has been understood for these many centuries, the real reason of this remarkable change in a wholesome fruit juice was not known until revealed by recent progress in chemistry, and by the use of the microscope. We know now that the change is due to fermentation, brought about from the influence, and by the action, of bacteria (sec. 125).

In other words, fermentation is the result of the growth of low form of vegetable life known as an organised ferment. The ferment, whether it be the commonly used brewer's yeast, or any other species of alcoholic ferment, has the power to decompose or break down a large part of the sugar present in the liquid into alcohol, which remains as a poison, and carbon dioxid, which escapes more or less completely.

Thus man, ever prone to do evil, was once obliged, in his ignorance, to make his alcoholic drinks in the crudest manner; but now he has forced into his service the latest discoveries in science, more especially in bacteriology, that he may manufacture more scientifically and more economically alcoholic beverages of all sorts and kinds, and distribute them broadcast all over God's earth for the physical and moral ruin of the people.



Disinfectants.

400. Disinfectants, Antiseptics, and Deodorants. The word disinfectant is synonymous with the term bactericide or germicide. A disinfectant is a substance which destroys infectious material. An antiseptic is an agent which may hinder the growth, but does not destroy the vitality, of bacteria. A deodorant is not necessarily a disinfectant, or even an antiseptic, but refers to a substance that destroys or masks offensive odors.

401. Air and Water as Disinfectants. Nature has provided for our protection two most efficient means of disinfection,—pure air (sec. 218) and pure water (sec. 119). The air of crowded rooms contains large quantities of bacteria, whereas in pure air there are comparatively few, especially after rain, which carries them to the earth. Living micro-organisms have never been detected in breezes coming from the sea, but in those blowing out from the shore large numbers may be found.

In water tainted with organic matter putrefactive bacteria will flourish, whereas pure water is fatal to their existence. Surface water, because it comes from that part of the soil where bacteria are most active, and where there is most organic matter, generally contains great quantities of these organisms. In the deeper strata of the soil there is practically no decomposition of organic matter going on, hence, water taken from deep sources is comparatively free from bacteria. For this reason, deep well water is greatly to be preferred for drinking purposes to that from surface wells.

402. Disinfectants. It is evident that air and water are not always sufficient to secure disinfection, and this must be accomplished by other means. The destruction of infected material by fire is, of course, a sure but costly means of disinfection. Dry heat, steam, and boiling water are valuable disinfectants and do not injure most fabrics. These agents are generally used in combination with various chemical disinfectants.

Certain chemical agents that are capable of destroying micro-organisms and their spores have come, of late years, into general use. A form of mercury, called corrosive sublimate, is a most efficacious and powerful germicide, but is exceedingly poisonous and can be bought only under restrictions.[54] Carbolic acid, chloride of lime, permanganate of potash, and various other preparations made from zinc, iron, and petroleum, are the chemical disinfectants most commonly and successfully used at the present time. There are also numerous varieties of commercial disinfectants now in popular use, such as Platt's chlorides, bromo-chloral, sanitas, etc., which have proved efficient germicides.



Instructions for the Management of Contagious Diseases.

The following instructions for the management of contagious diseases were prepared for the National Board of Health by an able corps of scientists and experienced physicians.

403. Instructions for Disinfection. Disinfection is the destruction of the poisons of infectious and contagious diseases. Deodorizers, or substances which destroy smells, are not necessarily disinfectants, and disinfectants do not necessarily have an odor. Disinfection cannot compensate for want of cleanliness nor of ventilation.

404. Disinfectants to be Employed. 1. Roll sulphur (brimstone); for fumigation.

2. Sulphate of iron (copperas) dissolved in water in the proportion of one and a half pounds to the gallon; for soil, sewers, etc.

[NOTE. A most useful little manual to consult in connection with this chapter is the Hand-Book of Sanitary Information, written by Roger S. Tracy, Sanitary Inspector of the New York City Health Department. Price, 50 cents.]

3. Sulphate of zinc and common salt, dissolved together in water in the proportion of four ounces sulphate and two ounces salt to the gallon; for clothing, bed-linen, etc.

405. How to Use Disinfectants. 1. In the sick-room. The most available agents are fresh air and cleanliness. The clothing, towels, bed-linen, etc., should, on removal from the patient, and before they are taken from the room, be placed in a pail or tub of the zinc solution, boiling-hot, if possible.

All discharges should either be received in vessels containing copperas solution, or, when this is impracticable, should be immediately covered with copperas solution. All vessels used about the patient should be cleansed with the same solution.

Unnecessary furniture, especially that which is stuffed, carpets, and hangings, should, when possible, be removed from the room at the outset; otherwise they should remain for subsequent fumigation and treatment.

2. Fumigation. Fumigation with sulphur is the only practicable method for disinfecting the house. For this purpose, the rooms to be disinfected must be vacated. Heavy clothing, blankets, bedding, and other articles which cannot be treated with zinc solution, should be opened and exposed during fumigation, as directed below. Close the rooms as tightly as possible, place the sulphur in iron pans supported upon bricks placed in washtubs containing a little water, set it on fire by hot coals or with the aid of a spoonful of alcohol, and allow the room to remain closed for twenty-four hours. For a room about ten feet square, at least two pounds of sulphur should be used; for larger rooms, proportionally increased quantities.[55]

3. Premises. Cellars, yards, stables, gutters, privies, cesspools, water-closets, drains, sewers, etc., should be frequently and liberally treated with copperas solution. The copperas solution is easily prepared by hanging a basket containing about sixty pounds of copperas in a barrel of water.[56]

4. Body and bed clothing, etc. It is best to burn all articles which have been in contact with persons sick with contagious or infectious diseases. Articles too valuable to be destroyed should be treated as follows:

(a) Cotton, linen, flannels, blankets, etc., should be treated with the boiling-hot zinc solution; introduce piece by piece, secure thorough wetting, and boil for at least half an hour.

(b) Heavy woolen clothing, silks, furs, stuffed bed-covers, beds, and other articles which cannot be treated with the zinc solution, should be hung in the room during fumigation, their surfaces thoroughly exposed and pockets turned inside out. Afterward they should be hung in the open air, beaten, and shaken. Pillows, beds, stuffed mattresses, upholstered furniture, etc., should be cut open, the contents spread out and thoroughly fumigated. Carpets are best fumigated on the floor, but should afterward be removed to the open air and thoroughly beaten.

Books for Collateral Study. Among the many works which may be consulted with profit, the following are recommended as among those most useful: Parkes Elements of Health; Canfield's Hygiene of the Sick-Room; Coplin & Bevan's Practical Hygiene; Lincoln's School Hygiene; Edward Smith's Health; McSherrys Health; American Health Primers (12 little volumes, edited by Dr. Keen of Philadelphia); Reynold's Primer of Health; Corfield's Health; Appleton's Health Primers; Clara S. Weeks' Nursing; Church's Food; Yeo's Food in Health and Disease; Hampton's Nursing, its Principles and Practice; Price's Nurses and Nursing; Cullinworth's Manual of Nursing; Wise's Text-Book of Nursing (2 vols.); and Humphrey's Manual of Nursing.



Chapter XV.

Experimental Work in Physiology.



406. The Limitations of Experimental Work in Physiology in Schools. Unlike other branches of science taught in the schools from the experimental point of view, the study of physiology has its limitations. The scope and range of such experiments is necessarily extremely limited compared with what may be done with the costly and elaborate apparatus of the medical laboratory. Again, the foundation of physiology rests upon systematic and painstaking dissection of the dead human body and the lower animals, which mode of study very properly is not permitted in ordinary school work. Experiments upon the living human body and the lower animals, now so generally depended upon in our medical and more advanced scientific schools, for obvious reasons can be performed only in a crude and quite superficial manner in secondary schools.

Hence in the study of physiology in schools many things must be taken for granted. The observation and experience of medical men, and the experiments of the physiologist in his laboratory must be depended upon for data which cannot be well obtained at first hand by young students.

407. Value of Experiments in Physiology in Secondary Schools. While circumstances and regard for certain proprieties of social life forbid the use of a range of experiments, in anatomy and physiology, such as are permitted in other branches of science in secondary schools, it by no means follows that we are shut out altogether from this most important and interesting part of the study. However simple and crude the apparatus, the skillful and enthusiastic teacher has at his command a wide series of materials which can be profitably utilized for experimental instruction. As every experienced teacher knows, pupils gain a far better knowledge, and keep up a livelier interest in any branch of science, if they see with their own eyes and do with their own hands that which serves to illuminate and illustrate the subject-matter.

[NOTE. For additional suggestions and practical helps on the subject of experimental work in physiology the reader is referred to Blaisdell's How to Teach Physiology, a handbook for teachers. A copy of this pamphlet will be sent postpaid to any address by the publishers of this book on receipt of ten cents.]

The experimental method of instruction rivets the attention and arouses and keeps alive the interest of the young student; in fact, it is the only true method of cultivating a scientific habit of study[57]. The subject-matter as set forth on the printed pages of this book should be mastered, of course, but at the same time the topics discussed should be illuminated and made more interesting and practical by a well-arranged series of experiments, a goodly show of specimens, and a certain amount of microscopical work.

408. The Question of Apparatus. The author well understands from personal experience the many practical difficulties in the way of providing a suitable amount of apparatus for classroom use. If there are ample funds for this purpose, there need be no excuse or delay in providing all that is necessary from dealers in apparatus in the larger towns, from the drug store, markets, and elsewhere. In schools where both the funds and the time for such purposes are limited, the zeal and ingenuity of teachers and students are often put to a severe test. Fortunately a very little money and a great deal of ingenuity and patience will do apparent wonders towards providing a working supply of apparatus.

It will be noticed that many of the experiments in the preceding chapters of this book can be performed with very simple, and often a crude and home-made sort of apparatus. This plan has been rigidly followed by the author, first, because he fully realizes the limitations and restrictions of the subject; and secondly, because he wishes to emphasize the fact that expensive and complicated apparatus is by no means necessary to illustrate the great principles of anatomy and physiology.

409. Use of the Microscope. To do thorough and satisfactory work in physiology in our higher schools a compound microscope is almost indispensable. Inasmuch as many of our best secondary schools are equipped with one or more microscopes for use in other studies, notably botany, it is much less difficult than it was a few years ago to obtain this important help for the classes in physiology.



For elementary class work a moderate-priced, but well-made and strong, instrument should be provided. If the school does not own a microscope, the loan of an instrument should be obtained for at least a few weeks from some person in the neighborhood.

The appearance of the various structures and tissues of the human body as revealed by the microscope possesses a curious fascination for every observer, especially for young people. No one ever forgets the first look at a drop of blood, or the circulation of blood in a frog's foot as shown by the microscope.

[NOTE. For detailed suggestions in regard to the manipulation and use of the microscope the student is referred to any of the standard works on the subject. The catalogues of scientific-instrument makers of our larger cities generally furnish a list of the requisite materials or handbooks which describe the use of the various microscopes of standard make.

The author is indebted to Bergen's Elements of Botany for the following information concerning the different firms which deal in microscopes. "Several of the German makers furnish excellent instruments for use in such a course as that here outlined. The author is most familar with the Leitz microscopes, which are furnished by Wm. Krafft, 411 West 59th St., New York city, or by the Franklin Educational Co., 15 and 17 Harcourt St., Boston. The Leitz Stand, No. IV., can be furnished duty free (for schools only), with objectives 1, 3, and 5, eye-pieces I. and III., for $24.50. If several instruments are being provided, it would be well to have part of them equipped with objectives 3 and 7, and eye-pieces I. and III.

"The American manufacturers, Bausch & Lomb Optical Company, Rochester, N.Y., and No. 130 Fulton St., New York city, have this year produced a microscope of the Continental type which is especially designed to meet the requirements of the secondary schools for an instrument with rack and pinion coarse adjustment and serviceable fine adjustment, at a low price. They furnish this new stand, 'AAB,' to schools and teachers at 'duty-free' rates, the prices being for the stand with two eye-pieces (any desired power), 2/3-inch and 1/4-inch objectives, $25.60, or with 2-inch, 2/3-inch, and 1/4-inch objectives, and two eye-pieces, $29.20. Stand 'A,' the same stand as the 'AAB,' without joint and with sliding tube coarse adjustment (as in the Leitz Stand IV.), and with three eye-pieces and 2/3-inch and 1/4-inch objectives, is furnished for $20.40. Stand 'A,' with two eye-pieces, 2/3-inch and 1/6-inch objectives, $20.40."]

410. The Use of the Skeleton and Manikin. The study of the bones by the help of a skeleton is almost a necessity. To this intent, schools of a higher grade should be provided both with a skeleton and a manikin. If the former is not owned by the school, oftentimes a loan of one can be secured of some medical man in the vicinity. Separate bones will also prove useful. In fact, there is no other way to study properly the structure and use of the bones and joints than by the bones themselves. A good manikin is also equally serviceable, although not so commonly provided for schools on account of its cost.

411. The Question of Vivisection and Dissection. There should be no question at all concerning vivisection. In no shape or form should it be allowed in any grade of our schools. Nor is there any need of much dissection in the grammar-school grades. A few simple dissections to be performed with fresh beef-joints, tendons of turkey legs, and so on, will never engender cruel or brutal feelings toward living things. In the lower grades a discreet teacher will rarely advise his pupils to dissect a dead cat, dog, frog, or any other animal. Instead of actual dissection, the pupils should examine specimens or certain parts previously dissected by the teacher,—as the muscles and tendons of a sheep, the heart of an ox, the eye of a codfish, and so on. Even under these restrictions the teacher should not use the knife or scissors before the class to open up any part of the specimen. In brief, avoid everything that can possibly arouse any cruel or brutal feeling on the part of young students.

In the higher schools, in normal and other training schools, different conditions prevail. Never allow vivisection in any form whatever, either in school or at home. Under the most exact restrictions students in these schools may be taught to make a few simple dissections.

Most teachers will find, however, even in schools of a higher grade, that the whole subject is fraught with many difficulties. It will not require much oftentimes to provoke in a community a deal of unjust criticism. A teacher's good sense and discretion are often put to a severe test.



Additional Experiments.

To the somewhat extended list of experiments as described in the preceding chapters a few more are herewith presented which may be used as opportunity allows to supplement those already given.

Experiment 193. To examine white fibrous tissue. Snip off a very minute portion from the muscle of a rabbit, or any small animal recently dead. Tease the specimen with needles, mount in salt solution and examine under a high power. Note the course and characters of the fibers.

Experiment 194. To examine elastic tissue. Tease out a small piece of ligament from a rabbit's leg in salt solution; mount in the same, and examine as before. Note the curled elastic fibers.

Experiment 195. To examine areolar tissue. Gently tease apart some muscular fibers, noting that they are attached to each other by connective tissue. Remove a little of this tissue to a slide and examine as before. Examine the matrix with curled elastic fiber mixed with straight white fibers.

Experiment 196. To examine adipose tissue. Take a bit of fat from the mesentery of a rabbit. Tease the specimen in salt solution and mount in the same. Note the fat cells lying in a vascular meshwork.

Experiment 197. To examine connective tissues. Take a very small portion from one of the tendons of a rabbit, or any animal recently dead; place upon a glass slide with a drop of salt solution; tease it apart with needles, cover with thin glass and examine with microscope. The fine wavy filaments will be seen. Allow a drop of dilute acetic acid to run under the cover glass; the filaments will swell and become transparent.

Experiment 198. Tease out a small piece of ligament from the rabbit's leg in salt solution; mount in the same, and examine under a high power. Note the curled elastic fibers.

Experiment 199. A crude experiment to represent the way in which a person's neck is broken. Bring the ends of the left thumb and the left second finger together in the form of a ring. Place a piece of a wooden toothpick across it from the middle of the finger to the middle of the thumb. Put the right forefinger of the other hand up through the front part to represent the odontoid process of the axis, and place some absorbent cotton through the other part to represent the spinal cord. Push backwards with the forefinger with just enough force to break the toothpick and drive its fragments on to the cotton.

Experiment 200. To illustrate how the pulse-wave is transmitted along an artery. Use the same apparatus as in Experiment 106, p. 201. Take several thin, narrow strips of pine wood. Make little flags by fastening a small piece of tissue paper on one end of a wooden toothpick. Wedge the other end of the toothpick into one end of the strips of pine wood. Use these strips like levers by placing them across the long rubber tube at different points. Let each lever compress the tube a little by weighting one end of it with a blackboard eraser or book of convenient size.

As the pulse-wave passes along under the levers they will be successively raised, causing a slight movement of the tissue-paper flags.

Experiment 201. The dissection of a sheep's heart. Get a sheep's heart with the lungs attached, as the position of the heart will be better understood. Let the lungs be laid upon a dish so that the heart is uppermost, with its apex turned toward the observer.

The line of fat which extends from the upper and left side of the heart downwards and across towards the right side, indicates the division between the right and left ventricles.

Examine the large vessels, and, by reference to the text and illustrations, make quite certain which are the aorta, the pulmonary artery, the superior and inferior venae cavae, and the pulmonary veins.

Tie variously colored yarns to the vessels, so that they may be distinguished when separated from the surrounding parts.

Having separated the heart from the lungs, cut out a portion of the wall of the right ventricle towards its lower part, so as to lay the cavity open. Gradually enlarge the opening until the chordae tendineae and the flaps of the tricuspid valve are seen. Continue to lay open the ventricle towards the pulmonary artery until the semilunar valves come into view.

The pulmonary artery may now be opened from above so as to display the upper surfaces of the semilunar valves. Remove part of the wall of the right auricle, and examine the right auriculo-ventricular opening.

The heart may now be turned over, and the left ventricle laid open in a similar manner. Notice that the mitral valve has only two flaps. The form of the valves is better seen if they are placed under water, and allowed to float out. Observe that the walls of the left ventricle are much thicker than those of the right.

Open the left auricle, and notice the entrance of the pulmonary veins, and the passage into the ventricle.

The ventricular cavity should now be opened up as far as the aorta, and the semilunar valves examined. Cut open the aorta, and notice the form of the semilunar valves.

Experiment 202. To show the circulation in a frog's foot (see Fig. 78, p. 192). In order to see the blood circulating in the membrane of a frog's foot it is necessary to firmly hold the frog. For this purpose obtain a piece of soft wood, about six inches long and three wide, and half an inch thick. At about two inches from one end of this, cut a hole three-quarters of an inch in diameter and cover it with a piece of glass, which should be let into the wood, so as to be level with the surface. Then tie up the frog in a wet cloth, leaving one of the hind legs outside. Next, fasten a piece of cotton to each of the two longest toes, but not too tightly, or the circulation will be stopped and you may hurt the frog.

Tie the frog upon the board in such a way that the foot will just come over the glass in the aperture. Pull carefully the pieces of cotton tied to the toes, so as to spread out the membrane between them over the glass. Fasten the threads by drawing them into notches cut in the sides of the board. The board should now be fixed by elastic bands, or by any other convenient means, upon the stage of the microscope, so as to bring the membrane of the foot under the object glass.

The flow of blood thus shown is indeed a wonderful sight, and never to be forgotten. The membrane should be occasionally moistened with water.

Care should be taken not to occasion any pain to the frog.

Experiment 203. To illustrate the mechanics of respiration[58] (see Experiment 122, p. 234). "In a large lamp-chimney, the top of which is closed by a tightly fitting perforated cork (A), is arranged a pair of rubber bags (C) which are attached to a Y connecting tube (B), to be had of any dealer in chemical apparatus or which can be made by a teacher having a bunsen burner and a little practice in the manipulation of glass (Fig. 171). From the center of the cork is attached a rubber band by means of a staple driven through the cork, the other end of which (D) is attached to the center of a disk of rubber (E) such as dentists use. This disk is held to the edge of the chimney by a wide elastic band (F). There is a string (G) also attached to the center of the rubber disk by means of which the diaphragm may be lowered.



Such is a description of the essentials of the model. The difficulties encountered in its construction are few and easily overcome. In the first place, the cork must be air-tight, and it is best made so by pouring a little melted paraffin over it, care being taken not to close the tube. The rubber bags were taken from toy balloon-whistles.

In the construction of the diaphragm, it is to be remembered that it also must be air-tight, and in order to resemble the human diaphragm, it must have a conical appearance when at rest. In order to avoid making any holes in the rubber, the two attachments (one of the rubber band, and the other of the string) were made in this wise: the rubber was stretched over a button having an eye, then under the button was placed a smaller ring from an old umbrella; to this ring was attached the rubber band, and to the eye of the button was fastened the operating string. When not in use the diaphragm should be taken off to relieve the strain on the rubber band."

Experiment 204. To illustrate the action of the intercostal muscles (see sec. 210). The action of the intercostal muscles is not at first easy to understand; but it will be readily comprehended by reference to a model such as that represented in Fig. 172. This maybe easily made by the student himself with four laths of wood, fastened together at the corners, A, B, C, D, with pins or small screws, so as to be movable. At the points E, F, G, H, pins are placed, to which elastic bands may be attached (A). B D represents the vertebral column; A C, the sternum; and A B and C D, the ribs. The elastic band F G represents the external intercostal muscles, and E H, the internal intercostals.



If now the elastic band E H be removed, the remaining band, F G, will tend to bring the two points to which it is attached, nearer together, and the result will be that the bars A B and C D will be drawn upwards (B), that is, in the same direction as the ribs in the act of inspiration. When the elastic band E H is allowed to exert its force, the opposite effect will be produced (C); in this case representing the position of the ribs in an act of expiration.

Experiment 205. Pin a round piece of bright red paper (large as a dinner-plate) to a white wall, with a single pin. Fasten a long piece of thread to it, so it can be pulled down in a moment. Gaze steadily at the red paper. Have it removed while looking at it intently, and a greenish spot takes its place.

Experiment 206. Lay on different parts of the skin a small, square piece of paper with a small central hole in it. Let the person close his eyes, while another person gently touches the uncovered piece of skin with cotton wool, or brings near it a hot body. In each case ask the observed person to distinguish between them. He will always succeed on the volar side of the hand, but occasionally fail on the dorsal surface of the hand, the extensor surface of the arm, and very frequently on the skin of the back.

Experiment 207. Wheatstone's fluttering hearts. Make a drawing of a red heart on a bright blue ground. In a dark room lighted by a candle hold the picture below the level of the eyes and give it a gentle to-and-fro motion. On continuing to look at the heart it will appear to move or flutter over the blue background.

Experiment 208. At a distance of six inches from the eyes hold a veil or thin gauze in front of some printed matter placed at a distance of about two feet. Close one eye, and with the other we soon see either the letters distinctly or the fine threads of the veil, but we cannot see both equally distinct at the same time. The eye, therefore, can form a distinct image of a near or distant object, but not of both at the same time; hence the necessity for accommodation.

Experiment 209. Place a person in front of a bright light opposite a window, and let him look at the light; or place one's self opposite a well-illuminated mirror. Close one eye with the hand and observe the diameter of the other pupil. Then suddenly remove the hand from the closed eye: light falls upon it; at the same time the pupil of the other eye contracts.

Experiment 210. To illustrate the blind spot. Marriott's experiment. On a white card make a cross and a large dot, either black or colored. Hold the card vertically about ten inches from the right eye, the left being closed. Look steadily at the cross with the right eye, when both the cross and the circle will be seen. Gradually approach the card toward the eye, keeping the axis of vision fixed on the cross. At a certain distance the circle will disappear, i.e., when its image falls on the entrance of the optic nerve. On bringing the card nearer, the circle reappears, the cross, of course, being visible all the time (see Experiment 180, p. 355).

Experiment 211. To map out the field of vision. A crude method is to place the person with his back to a window, ask him to close one eye, stand in front of him about two feet distant, hold up the forefingers of both hands in front of and in the plane of your own face. Ask the person to look steadily at your nose, and as he does so observe to what extent the fingers can be separated horizontally, vertically, and in oblique directions before they disappear from his field of vision.

Experiment 212. To illustrate imperfect judgment of distance. Close one eye and hold the left forefinger vertically in front of the other eye, at arm's length, and try to strike it with the right forefinger.

On the first trial one will probably fall short of the mark, and fail to touch it. Close one eye, and rapidly try to dip a pen into an inkstand, or put a finger into the mouth of a bottle placed at a convenient distance. In both cases one will not succeed at first.

In these cases one loses the impressions produced by the convergence of the optic axes, which are important factors in judging of distance.

Experiment 213. Hold a pencil vertically about twelve inches from the nose, fix it with both eyes, close the left eye, and then hold the right index finger vertically, so as to cover the lower part of the pencil. With a sudden move, try to strike the pencil with the finger. In every case one misses the pencil and sweeps to the right of it.

Experiment 214. To illustrate imperfect judgment of direction. As the retina is spherical, a line beyond a certain length when looked at always shows an appreciable curvature.

Hold a straight edge just below the level of the eyes. Its upper margin shows a slight concavity.



Surface Anatomy and Landmarks.

In all of our leading medical colleges the students are carefully and thoroughly drilled on a study of certain persons selected as models. The object is to master by observation and manipulation the details of what is known as surface anatomy and landmarks. Now while detailed work of this kind is not necessary in secondary schools, yet a limited amount of study along these lines is deeply interesting and profitable. The habit of looking at the living body with anatomical eyes and with eyes at our fingers' ends, during the course in physiology, cannot be too highly estimated.

In elementary work it is only fair to state that many points of surface anatomy and many of the landmarks cannot always be defined or located with precision. A great deal in this direction can, however, be done in higher schools with ingenuity, patience, and a due regard for the feelings of all concerned. Students should be taught to examine their own bodies for this purpose. Two friends may thus work together, each serving as a "model" to the other.

To the following syllabus may be added such other similar exercises as ingenuity may suggest or time permit.



Syllabus.



I. Bony Landmarks.

1. The occipital protuberance can be distinctly felt at the back of the head. This is always the thickest part (often three-quarters of an inch or more) of the skull-cap, and is more prominent in some than in others. The thinnest part is over the temples, where it may be almost as thin as parchment.

2. The working of the condyle of the lower jaw vertically and from side to side can be distinctly felt and seen in front of the ear. When the mouth is opened wide, the condyle advances out of the glenoid cavity, and returns to its socket when the mouth is shut. In front of the ear, lies the zygoma, one of the most marked and important landmarks to the touch, and in lean persons to the eye.

3. The sliding movement of the scapula on the chest can be properly understood only on the living subject. It can move not only upwards and downwards, as in shrugging the shoulders, backwards and forwards, as in throwing back the shoulders, but it has a rotary movement round a movable center. This rotation is seen while the arm is being raised from the horizontal to the vertical position, and is effected by the cooperation of the trapezius with the serratus magnus muscles.

4. The patella, or knee-pan, the two condyles of the tibia, the tubercle on the tibia for the attachment of the ligament of the patella, and the head of the fibula are the chief bony landmarks of the knee. The head of the fibula lies at the outer and back part of the tibia. In extension of the knee, the patella is nearly all above the condyles. The inner border of the patella is thicker and more prominent than the outer, which slopes down toward its condyle.

5. The short, front edge of the tibia, called the "shin," and the broad, flat, subcutaneous surface of the bone can be felt all the way down. The inner edge can be felt, but not so plainly.

6. The head of the fibula is a good landmark on the outer side of the leg, about one inch below the top of the tibia. Note that it is placed well back, and that it forms no part of the knee joint, and takes no share in supporting the weight. The shaft of the fibula arches backwards and is buried deep among the muscles, except at the lower fourth, which can be distinctly felt.

7. The malleoli form the great landmarks of the ankle. The outer malleolus descends lower than the inner. The inner malleolus advances more to the front and does not descend so low as the outer.

8. The line of the clavicle, or collar bone, and the projection of the joint at either end of it can always be felt. Its direction is not perfectly horizontal, but slightly inclined downwards. We can distinctly feel the spine of the scapula and its highest point, the acromion.

9. Projecting beyond the acromion (the arm hanging by the side), we can feel, through the fibers of the deltoid, the upper part of the humerus. It distinctly moves under the hand when the arm is rotated. It is not the head of the bone which is felt, but its prominences (the tuberosities). The greater, externally; the lesser in front.

10. The tuberosities of the humerus form the convexity of the shoulder. When the arm is raised, the convexity disappears,—there is a slight depression in its place. The head of the bone can be felt by pressing the fingers high up in the axilla.

11. The humerus ends at the elbow in two bony prominences (internal and external condyles). The internal is more prominent. We can always feel the olecranon. Between this bony projection of the ulna and the internal condyle is a deep depression along which runs the ulna nerve (commonly called the "funny" or "crazy" bone).

12. Turn the hand over with the palm upwards, and the edge of the ulna can be felt from the olecranon to the prominent knob (styloid process) at the wrist. Turn the forearm over with the palm down, and the head of the ulna can be plainly felt and seen projecting at the back of the wrist.

13. The upper half of the radius cannot be felt because it is so covered by muscles; the lower half is more accessible to the touch.

14. The three rows of projections called the "knuckles" are formed by the proximal bones of the several joints. Thus the first row is formed by the ends of the metacarpals, the second by the ends of the first phalanges, and the third by the ends of the second phalanges. That is, in all cases the line of the joints is a little in advance of the knuckles and nearer the ends of the fingers.



II. Muscular Landmarks.

1. The position of the sterno-mastoid muscle as an important and interesting landmark of the neck has already been described (p. 70).

2. If the left arm be raised to a vertical position and dropped to a horizontal, somewhat vigorously, the tapering ends of the pectoralis major and the tendons of the biceps and deltoid may be felt by pressing the parts in the axilla between the fingers and thumb of the right hand.

3. The appearance of the biceps as a landmark of the arm has already been described (p. 70). The action of its antagonist, the triceps, may be studied in the same manner.

4. The sartorius is one of the fleshy landmarks of the thigh, as the biceps is of the arm, and the sterno-cleido-mastoid of the neck. Its direction and borders may be easily traced by raising the leg,—a movement which puts the muscle in action.

5. If the model be directed to stand on tiptoe, both of the large muscles of the calf, the gastrocnemius and soleus, can be distinguished.

6. Direct the model, while sitting upright, to cross one leg over the other, using his utmost strength. The great muscles of the inner thigh are fully contracted. Note the force required to pull the legs to the ordinary position.

7. With the model lying in a horizontal position with both legs firmly held together, note the force required to pull the feet apart while the great muscles of the thigh are fully contracted.

8. In forcible and resisted flexion of the wrist two tendons come up in relief. On the outer side of one we feel the pulse at the wrist, the radial artery here lying close to the radius.

9. On the outer side of the wrist we can distinctly see and feel when in action, the three extensor tendons of the thumbs. Between two of them is a deep depression at the base of the thumb, which the French call the "anatomical tobacco box."

10. The relative position of the several extensor tendons on the back of the wrist and fingers as they play in their grooves over the back of the radius and ulna can be distinctly traced when the several muscles are put in action.