Not infrequently it is best to check symptoms, and to check them by means of drugs. When they should be checked, only a thoroughly trained physician is qualified to decide. The question is not one for amateurs, since the whole practice of medicine, including the prescription of drugs, constantly becomes more nearly an exact science. People should obtain and follow expert advice in regard to health as they would in regard to other affairs of life. The constant self-dosing practised by thousands of people is harmful and unintelligent; it is, however, no less irrational to go to the other extreme and refuse to take medicine prescribed by a competent doctor.

AMATEUR DOSING.--Amateur dosing either of oneself or of others is dangerous in more ways than one. In the first place, time is lost.

Moreover, symptoms are characteristic; checking or altering them increases the difficulty of finding the real trouble. The man with eyestrain who takes one drug to stop his headache and another to "cure"

his stomach, is simply delaying the time when properly adjusted gla.s.ses will relieve both. In this case the result may not be serious; but such a loss of time in finding the trouble and beginning proper treatment might prove fatal in the case of tuberculosis.

Another objection to amateur prescription of medicine is the fact that most drugs have more than one effect. In addition to their main action they have others, subordinate or ordinarily less marked. These minor effects may be serious in some cases. Many headache remedies, for example, affect the heart; a dose that is harmless for a normal person may be strong enough to injure seriously a person with a weak heart. A doctor, and a doctor only, is competent to decide when and in what quant.i.ty medicines will be beneficial, because he alone understands both the condition of the patient and all the possible effects of the drug.

In no circ.u.mstances should medicine prescribed for one person be taken by another. This rule seems obvious enough; yet every day people pa.s.s on their pet remedies to friends. Some medicines deteriorate after standing, and others grow stronger; nevertheless, medicine supposed to have cured a cough or a tonic supposed to have strengthened some member of the family after an attack of grippe is cheerfully administered months later to another member of the family, who, to make matters worse, may differ in age, strength, and probably in the nature of his sickness. Drugs are expensive, and it is considered economical to use them up; measured by lost time and impaired health such practices may be anything but thrifty.

Cathartics, tonics, and various drugs to relieve pain and sleeplessness are among the remedies most commonly taken without medical advice.

Enough has already been said about constipation to indicate proper hygienic treatment, but another warning should be given against habitual use of cathartics. Many of these drugs are irritating; even when not irritating, they are harmful, since the body depends more and more upon the drug to do for it what it should be enabled to do for itself, by remedying the original cause of the trouble. Licorice powder, cascara, saline cathartics such as Seidlitz powders and Roch.e.l.le Salts and some others are harmless for occasional use, if occasional is not too liberally interpreted.

Tonics are poor subst.i.tutes for proper diet, rest, and fresh air. Using them may be likened to beating a tired horse; the horse goes faster, but he is not really stronger. In some emergencies the horse must go faster and there is nothing to do but beat him, and in some cases the tonic should be given; these, however, are cases for a doctor to decide.

People persist in taking tonics because they are unwilling or unable to rest, or otherwise to change their ways of living.

Medicines to stop pain or to induce sleep are probably the most pernicious of all self-prescribed remedies, for they add to other dangers the possibility of forming drug habits. These habits are so insidious and so powerful that it is not safe to take habit-forming drugs even once except by a doctor's direction. In short periods of time strong people, apparently firm in will and character, have acquired habits from supposedly moderate use of drugs like morphine, cocaine, and alcohol. No one, no matter how sure of his own self-control, can afford to run so grave a risk.

PATENT REMEDIES.--Objections to self dosing in general apply even more strongly to using patent medicines. The ingredients of patent medicines are ordinarily unknown, so that using them is unintelligent at best.

Sometimes they contain habit-forming or other harmful drugs. In other cases the ingredients are innocent enough, but totally unable to bring about the results claimed for them. The old story about a powerful remedy discovered by accident and thus unknown to the medical profession deceives only the ignorant or credulous; with our present knowledge of chemistry and physiology powerful remedies are not discovered in that way.

Even to these comparatively harmless patent preparations there are two serious objections. One is the loss of time, during which the patient may grow worse. The other is that money is obtained under false pretenses; fraud is a common element in the success of patent remedies.

One of the least harmful, a substance called "Murine" may be taken as an example[2]. This substance was widely advertised at one time as a "positive cure for sore eyes." a.n.a.lysis showed it to be a solution of borax, which cost about five cents a gallon to prepare. It sold for one dollar an ounce, or at the rate of $128.00 a gallon. Although it could not bring about the wonderful cures advertised, it was practically harmless, and buyers of "Murine" must have been injured chiefly in pocket. But with "cancer cures" and "consumption cures" it is a different story. Early treatment of these diseases is essential to recovery; delay in many cases means robbing the sufferer of his only chance of life. No drugs are now known that will cure these diseases, and it seems incredible that anyone should be willing to practise such cruel deception upon ignorant people merely for the sake of making money.

ADMINISTRATION OF MEDICINE.--Medicines may be introduced into the body in a number of ways. In the majority of cases they are swallowed and finally carried to the tissues by the blood just as digested food is carried.

Except in rare emergencies no medicine should be given to a sick person without the doctor's order. The prescribed dose should be accurately measured in a medicine gla.s.s having a scale to show the number of teaspoonfuls. When measuring medicine, think only of what you are doing; neither talk nor listen to conversation. First read the label on the bottle. Next, shake the bottle, if the medicine is liquid, in order to mix the contents thoroughly. Then remove the cork with the second and third fingers, and hold it between them while pouring, thus keeping the cork clean and protecting the contents of the bottle. Hold the medicine gla.s.s on a level with the eyes, and in the other hand hold the bottle, with the side bearing the label uppermost to avoid soiling it; pour out the dose, measuring exactly, wipe the bottle, replace the cork, and again read the label on the bottle.

Most medicines should be diluted with a little water. Pills and capsules should not be presented to patients in the attendant's fingers, but on a saucer or teaspoon. Acids and medicines containing iron should be taken through a gla.s.s tube kept for medicine exclusively. Tubes and gla.s.ses should be washed at once after use, and neither they nor the bottles should stay in the patient's room. If a dose is omitted for any reason, do not increase the next dose; give the regular dose at the next regular time.

Serious mistakes in giving or taking drugs are far too common, and no precautions are too great to guard against them. Never use medicine from a box or bottle that has no label. Never take or give another person a medicine selected in the dark, even though you have positive knowledge that there is no other bottle or box of medicine in the whole house; in just such circ.u.mstances the fatal mistakes occur.

A few things can be done to make medicines more palatable. The water used to dilute the dose and to be taken after it should be very cold.

Holding the nose is helpful. A piece of cracker, a peppermint, or a slice of lemon or orange, if allowed, may be taken afterward. Giving disagreeable medicine in ordinary food, as lemon juice, orange juice, or milk, and giving bitter powders in jam or jelly, is unwise because it sometimes results in life long dislike for a useful article of diet.

Where food is given directly after the dose to take away its taste, the a.s.sociation of dislike seems to be formed less frequently.

The taste of castor oil is so disgusting that it often causes vomiting, but if skillfully given the oil need not be tasted by a patient who is willing to cooperate. Its way of sticking to the tongue and teeth const.i.tutes the chief difficulty; the object therefore is to prevent it from sticking by swallowing the dose all at once. To administer the oil, wet the inside of a medicine gla.s.s or large spoon with very cold water, and leave a little water in the bottom. Pour the required dose in slowly and cover it with more cold water. Let the patient hold in his hand something to take away the taste,--cracker, bread, peppermint, or whatever is allowed; for castor oil water is not very effectual. Then direct him to hold his nose, open his mouth, and hold his breath; caution him to let the oil run down without swallowing until all has been taken, and afterward to chew the cracker, continuing to hold his nose until he has swallowed the cracker. When the patient understands and is ready, pour the dose in quickly as far back as possible, taking care not to spill the last drop on the lips. This process may seem unduly troublesome, but when castor oil is needed it is badly needed and efforts to make it stay down are worth while. The following method also effectually disguises the taste of castor oil: place in a gla.s.s a teaspoonful of baking soda, add the prescribed dose of oil and then the juice of half a lemon. Mix all together thoroughly and let the patient take the mixture while it is effervescing. This method may be used unless the patient is not allowed soda and lemon juice. Castor oil may be bought in capsules, but on account of their size many people find the capsules impossible to swallow.

SUPPOSITORIES.--Sometimes medicines are given through the r.e.c.t.u.m. For this purpose they are combined with cocoa b.u.t.ter or other material, and made into small cones called suppositories. They melt at a low temperature and should be kept on ice until needed. A suppository should be lubricated with vaseline, and inserted very gently as far as the finger can be introduced, while the patient is lying on the back or left side.

ENEMATA.--An injection of a fluid into the r.e.c.t.u.m is called an enema.

(Plural, enemas, or enemata.) Enemas are generally used to cause evacuation of the bowels.

For a simple purgative enema one of the following is generally used: plain water; or a solution of common salt in the proportion of one teaspoonful of salt to one pint of water; or soap suds made with a white soap such as castile or ivory. Unless otherwise ordered the temperature of the enema should be between 105 and 110 F.

To give an enema, one should proceed as follows: First protect the bed by placing under the patient's hips a rubber sheet, covered by a draw sheet or large towel. Let the patient lie on the back, with the knees flexed and head low. Bring to the bedside a commode or bedpan, and lastly the solution contained in a fountain syringe having a long rubber tube, stopc.o.c.k and short hard rubber nozzle. The bag of the syringe may be hung on the bed post or elsewhere, but it should not be more than three feet at most above the patient's head. Lubricate the nozzle with vaseline either from a tube, or removed from a jar by means of a piece of toilet paper; never dip the nozzle itself into a vaseline jar. Let the solution flow into the bedpan until it runs warm and smoothly; a jerky flow means presence of air bubbles which cause pain if injected into the bowels. Unless the patient is able to do it herself, gently insert the nozzle, and at the same time start the flow. Force must not be used in inserting the nozzle, and the flow should be gentle; if the solution goes in rapidly the patient may be unable to retain it. If there is a desire to expel the enema as soon as the injection has begun, shut off the current and wait a minute, meanwhile making gentle pressure upon the patient's abdomen with one hand; then lower the bag a little and begin again. A grown person should take from two to four pints, and a child from one to two pints. After the enema is finished give the bedpan immediately; the enema will, however, be more effective if retained a few minutes. The bedpan should be given and removed according to the directions on page 176. Sometimes an enema is expelled with such violence that it soils the upper sheet; to protect the covers a rubber sheet may be spread over the patient's knees and legs. Since an enema sometimes causes nausea or faintness, a patient should be watched constantly during the process.

To give an enema to a baby one may use a small syringe having a soft rubber bulb with a nozzle directly attached, or the ordinary fountain syringe with the small, hard rubber tip designed for infants. The enema should be given in a warm room free from draughts, and the baby must be warmly covered throughout the process. First cover the lap with a pad or folded blanket. Upon the blanket place a warmed rubber sheet, and over the rubber a warm diaper. Hold the baby on your lap, so that he lies on his back with his knees drawn up. Hold his feet or legs firmly in your left hand. Lubricate the nozzle thoroughly with vaseline. Be sure that all the air is expelled from the syringe, and then proceed as already directed. A baby will take from two or three ounces up to half a pint or even more, according to the size of the child. After the injection is finished place a small vessel under the baby's hips, and hold it until the fluid has been expelled, keeping the child well covered all the time.

After being used, the nozzle of a fountain syringe should be washed with soap and water, boiled, dried and put away in a clean place. Inserting the nozzle into the bag of the syringe immediately after withdrawing it from the r.e.c.t.u.m is a filthy but not uncommon practice. The syringe should be kept clean inside and out; it should be washed in hot soapsuds, rinsed in clean hot water, drained, and when thoroughly dry wrapped in a clean towel or tissue paper. The ordinary fountain syringe hanging for months by a dirty string on a hook in the bath room is an unpleasant and generally an unclean object.

SPRAYS AND GARGLES.--Several other methods of administering medicines are occasionally employed. Some remedies may be applied directly to the throat by gargles, and to the nose and throat by sprays. The throat may be cleansed by gargling with a solution of a teaspoonful of baking soda or common salt in a gla.s.s of warm water. Nose sprays should not be used except under medical advice, and it is well to remember that if the mouth washes, gargles, and sprays advertised to be disinfectants were really strong enough to kill germs, they would be too harsh for common or continued use. The nozzles of nose and throat sprays should be boiled immediately after use. A surprising number of families who have progressed far beyond common drinking cups and towels, continue to use a common nose spray without even washing the nozzle. Children while they are well should be taught to gargle the throat; a child with a sore throat and an aching head is in a poor condition to learn anything.

INHALATION or breathing in, is another method used to introduce drugs into the membranes of the nose, throat, and lungs. Smelling salts are an example of substances used for inhalation; they are used to stimulate persons who are faint. They should not be placed close to the nostrils, nor used at all when the patient is totally unconscious.

Inhalations of steam are often used in asthma, croup, and bronchitis.

Special croup kettles are made for the purpose, but an ordinary pitcher half full of boiling water may be used instead. The patient's head should be held closely over the pitcher, and a towel should be adjusted around the top covering the patient's nose and mouth, but admitting just enough air to make it possible for him to breathe. If a drug is ordered it should be added to the water.

INUNCTION, or rubbing a substance into the skin, is sometimes ordered for delicate babies and children. After the skin of the abdomen has been washed with warm soapy water and thoroughly dried, the substance ordered, generally olive oil or cod liver oil, should be applied by means of a circular movement of the palm of the hand. The oil should be warm and the rubbing continued until it is absorbed.

Ointments are also applied by inunction. A small quant.i.ty at a time should be rubbed in, using a circular motion. If an ointment is ordered to be applied where the skin is broken, the ointment should be spread upon gauze and applied without friction. Liniments are rubbed in in the same way as ointments. In many cases rubbing accomplishes more than the ointment or liniment itself, so that this part of the treatment must not be slighted.

HOUSEHOLD MEDICINE CUPBOARD.--In every household a small cupboard is needed for medical and surgical supplies. Gla.s.s shelves are desirable, because they show when dirty and are easily cleaned, but a wooden cupboard can easily be lined with clean paper or white enamel cloth held in place with thumb tacks. Dirty, stained shelves should not be tolerated. The cupboard should be kept locked and the key put well out of the reach of children. In the cupboard should be kept medicines in daily use; they should not be paraded on family dinner tables.

Poisonous drugs should have rough gla.s.s bottles and conspicuous labels.

All medicine bottles should be kept well corked, since evaporation may take place and the remaining solution, by becoming stronger, may be dangerous to use in the ordinary amount. Pills and tablets sometimes deteriorate by standing, and may become so hard that they pa.s.s through the stomach and intestines without dissolving. It is best to buy drugs and surgical supplies in small quant.i.ties; when it is cheaper to buy more at a time the druggist should be asked whether they will deteriorate or not.

Almost every family needs to keep on hand some cathartics, some disinfectants, some material for first aid, and a few simple appliances.

Most families have certain other needs peculiar to themselves, and for those who live at a distance from drug stores a greater quant.i.ty and variety may be required. Elaborate equipment and extensive supplies of medicines are neither economical nor necessary for household use.

Castor oil, Roch.e.l.le or other laxative salts, and two grain cascara tablets ordinarily const.i.tute a sufficient supply of cathartics. The dose of castor oil is one or two teaspoonfuls for a baby up to a tablespoonful for an adult. Roch.e.l.le salts and seltzer aperient are given dissolved in water; the ordinary dose is from one to four teaspoonfuls. Seidlitz powders come in two packets, one white and one blue. The contents of the packets should first be dissolved in separate gla.s.ses each filled about a quarter full of water. One solution should then be poured into the other and the mixture taken while it is effervescing. Cascara tablets are generally given in one to ten grain doses.

A small bottle of tincture of iodine and one of 70% alcohol should be kept for disinfecting. Neither one is for internal use. The iodine is used to disinfect small wounds and abrasions of the skin. It is applied with cotton swabs and several swabs should be made and kept on hand in a box or envelope. Alcohol is used to disinfect thermometers and other instruments that cannot be boiled, for rubbing, and may also be used for disinfecting the skin. A 90% solution is sometimes used for rubbing; it need not be bought until needed. Denatured and wood alcohol are poisons and should be used in households only in spirit lamps; they are not safe for other purposes.

First aid materials may include two gauze bandages two and one-half inches wide and two bandages one inch wide, one American Red Cross First Aid Outfit, a small package of absorbent cotton, a roll of old muslin, a package of adhesive plaster one inch wide, boracic ointment, picric acid gauze or other application for burns, safety pins, and a pair of scissors.

For use in cases of fainting or exhaustion it is well to keep aromatic spirits of ammonia on hand. Its bottle should have a rubber stopper. The dose is one-half to one teaspoonful, in a quarter to half a gla.s.s of water. Hot coffee and tea are also good stimulants, but the time necessary to prepare them makes it desirable to have aromatic ammonia on hand. Household or ordinary ammonia must not be used as a subst.i.tute.

Olive oil, mustard, and baking soda may be brought from the kitchen when needed. It is a.s.sumed that vaseline, cold cream, hand lotion, talc.u.m powder, and other toilet preparations will also be available.

Only a few appliances are necessary. Among them are a medicine gla.s.s, a teaspoon, clinical thermometer, hot water bag, fountain syringe, and an alcohol lamp in houses without gas or electric stoves. It is better not to buy other appliances until they are needed, particularly rubber goods since they deteriorate rapidly.

EXERCISES

1. Why is it dangerous for persons without medical training to prescribe medicines? What is the especial danger of dosing oneself?

2. What is meant by a habit-forming drug? Name all you can, and tell why they are peculiarly dangerous.

3. What are the special objections to patent medicines?

4. What precautions should be taken in order to administer medicine accurately? What precautions to avoid giving wrong medicines?

5. How may some disagreeable medicines be made more palatable?

6. Tell how to prepare and give a soapsuds enema.

7. How should a fountain syringe be cared for? a throat spray?

8. Describe methods for giving steam inhalations.