For more detailed information about bandaging, the reader is referred to First Aid Manual, the authorised manual of the St John’s Ambulance Association, St Andrew’s Ambulance Association and British Red Cross Society.
When a death occurs at sea, the captain of the ship has authority to permit burial at sea. If, however, there are any doubts about cause of death, the captain may decide to preserve the body and refer the case to the relevant authorities at the next port of call.
Embalming is still used occasionally. The process consists in removing the internal organs through small openings, and ?lling the body cavities with various aromatics of antiseptic power – the skin being swathed in bandages or otherwise protected from the action of the air. Bodies are also preserved by injecting the blood vessels with strong antiseptics such as perchloride of mercury.
Cremation or incineration of the body is now the commonest method of disposal of the dead in the UK, where land for burials is increasingly scarce; today it accounts for around 75 per cent of disposals. The process of incineration takes 1–2 hours. Something in the range of 2·3 to 3·2 kg (5–7 lbs) of ash result from the combustion of the body, and there is no admixture with that from the fuel.
Cremation of a body means that it is almost impossible to conduct any meaningful forensic tests should any subsequent doubts be raised about the cause of death. So, before cremation can take place, two doctors have to sign the cremation forms. The ?rst is usually the doctor who was caring for the patient at the time of death – an important exception being cases of sudden death, when the coroner holds an inquest into the cause and authorises the necessary approval for cremation. In 1999, fewer than 3,500 deaths were certi?ed following a post-mortem, out of a total number of deaths in England and Wales of more than 556,000. When the coroner is not involved, the second doctor must have been quali?ed for ?ve years; he or she must be unconnected with the patient’s care and not linked professionally with the ?rst doctor. (For example, if the ?rst doctor is a general practitioner – as in the majority of cases they are – the second doctor should be from another practice.) Before signing the cremation certi?cate the second doctor must conduct an external examination of the dead person and discuss the circumstances of death with the ?rst doctor.
The two cremation forms are then inspected by crematorium medical referees who must be satis?ed that the cause of death has de?nitely been ascertained. The present death and cremation certi?cation system has been in place in the UK for many years – the legislative framework for cremation was set up in 1902 – and death certi?cation procedures were last reviewed by the government-appointed Brodrick committee in 1971, with no fundamental changes proposed. The case of Harold Shipman, a general practitioner convicted of murdering more than 15 patients, and suspected of murdering many more, has revealed serious weaknesses in the certi?cation system. A comprehensive review of the present procedures was in place at the time of writing (2004).... dead, disposal of the
Cramp Painful spasm of a muscle usually caused by excessive and prolonged contraction of the muscle ?bres. Cramps are common, especially among sportsmen and women, normally lasting a short time. The condition usually occurs during or immediately following exercise as a result of a build-up of LACTIC ACID and other chemical by-products in the muscles
– caused by the muscular e?orts. Cramps may occur more frequently, especially at night, in people with poor circulation, when the blood is unable to remove the lactic acid from the muscles quickly enough.
Repetitive movements such as writing (writer’s cramp) or operating a keyboard can cause cramp. Resting muscles may suffer cramp if a person sits or lies in an awkward position which limits local blood supply to them. Profuse sweating as a result of fever or hot weather can also cause cramp in resting muscle, because the victim has lost sodium salts in the sweat; this disturbs the biochemical balance in muscle tissue.
Treatment is to massage and stretch the affected muscle – for example, cramp in the calf muscle may be relieved by pulling the toes on the affected leg towards the knee. Persistent night cramps sometimes respond to treatment with a drug containing CALCIUM or QUININE. If cramp persists for an hour or more, the person should seek medical advice, as there may be a serious cause such as a blood clot impeding the blood supply to the area affected.
Dystrophy See myopathy below.
In?ammation (myositis) of various types may occur. As the result of injury, an ABSCESS may develop, although wounds affecting muscle generally heal well. A growth due to SYPHILIS, known as a gumma, sometimes forms a hard, almost painless swelling in a muscle. Rheumatism is a vague term traditionally used to de?ne intermittent and often migratory discomfort, sti?ness or pain in muscles and joints with no obvious cause. The most common form of myositis is the result of immunological damage as a result of autoimmune disease. Because it affects many muscles it is called POLYMYOSITIS.
Myasthenia (see MYASTHENIA GRAVIS) is muscle weakness due to a defect of neuromuscular conduction.
Myopathy is a term applied to an acquired or developmental defect in certain muscles. It is not a neurological disease, and should be distinguished from neuropathic conditions (see NEUROPATHY) such as MOTOR NEURONE DISEASE (MND), which tend to affect the distal limb muscles. The main subdivisions are genetically determined, congenital, metabolic, drug-induced, and myopathy (often in?ammatory) secondary to a distant carcinoma. Progressive muscular dystrophy is characterised by symmetrical wasting and weakness, the muscle ?bres being largely replaced by fatty and ?brous tissue, with no sensory loss. Inheritance may take several forms, thus affecting the sex and age of victims.
The commonest type is DUCHENNE MUSCULAR DYSTROPHY, which is inherited as a sex-linked disorder. It nearly always occurs in boys.
Symptoms There are three chief types of myopathy. The commonest, known as pseudohypertrophic muscular dystrophy, affects particularly the upper part of the lower limbs of children. The muscles of the buttocks, thighs and calves seem excessively well developed, but nevertheless the child is clumsy, weak on his legs, and has di?culty in picking himself up when he falls. In another form of the disease, which begins a little later, as a rule at about the age of 14, the muscles of the upper arm are ?rst affected, and those of the spine and lower limbs become weak later on. In a third type, which begins at about this age, the muscles of the face, along with certain of the shoulder and upper arm muscles, show the ?rst signs of wasting. All the forms have this in common: that the affected muscles grow weaker until their power to contract is quite lost. In the ?rst form, the patients seldom reach the age of 20, falling victims to some disease which, to ordinary people, would not be serious. In the other forms the wasting, after progressing to a certain extent, often remains stationary for the rest of life. Myopathy may also be acquired when it is the result of disease such as thyrotoxicosis (see under THYROID GLAND, DISEASES OF), osteomalacia (see under BONE, DISORDERS OF) and CUSHING’S DISEASE, and the myopathy resolves when the primary disease is treated.
Treatment Some myopathies may be the result of in?ammation or arise from an endocrine or metabolic abnormality. Treatment of these is the treatment of the cause, with supportive physiotherapy and any necessary physical aids while the patient is recovering. Treatment for the hereditary myopathies is supportive since, at present, there is no cure – although developments in gene research raise the possibility of future treatment. Physiotherapy, physical aids, counselling and support groups may all be helpful in caring for these patients.
The education and management of these children raise many diffculties. Much help in dealing with these problems can be obtained from Muscular Dystrophy Campaign.
Myositis ossi?cans, or deposition of bone in muscles, may be congenital or acquired. The congenital form, which is rare, ?rst manifests itself as painful swellings in the muscles. These gradually harden and extend until the child is encased in a rigid sheet. There is no e?ective treatment and the outcome is fatal.
The acquired form is a result of a direct blow on muscle, most commonly on the front of the thigh. The condition should be suspected whenever there is severe pain and swelling following a direct blow over muscle. The diagnosis is con?rmed by hardening of the swelling. Treatment consists of short-wave DIATHERMY with gentle active movements. Recovery is usually complete.
Pain, quite apart from any in?ammation or injury, may be experienced on exertion. This type of pain, known as MYALGIA, tends to occur in un?t individuals and is relieved by rest and physiotherapy.
Parasites sometimes lodge in the muscles, the most common being Trichinella spiralis, producing the disease known as TRICHINOSIS (trichiniasis).
Rupture of a muscle may occur, without any external wound, as the result of a spasmodic e?ort. It may tear the muscle right across – as sometimes happens to the feeble plantaris muscle in running and leaping – or part of the muscle may be driven through its ?brous envelope, forming a HERNIA of the muscle. The severe pain experienced in many cases of LUMBAGO is due to tearing of one of the muscles in the back. These conditions are usually relieved by rest and massage. Partial muscle tears, such as occur in sport, require more energetic treatment: in the early stages this consists of the application of an ice or cold-water pack, ?rm compression, elevation of the affected limb, rest for a day or so and then gradual mobilisation (see SPORTS MEDICINE).
Tumours occur occasionally, the most common being ?broid, fatty, and sarcomatous growths.
Wasting of muscles sometimes occurs as a symptom of disease in other organs: for example, damage to the nervous system, as in poliomyelitis or in the disease known as progressive muscular atrophy. (See PARALYSIS.)... muscles, disorders of
Uses Zinc chloride is a powerful caustic and astringent which, combined with zinc sulphate, is used as an astringent mouthwash. Zinc sulphate is also used in the form of eyedrops in the treatment of certain forms of conjunctivitis (see under EYE, DISORDERS OF).
Zinc oxide, zinc stearate, and zinc carbonate are made up in dusting powders, in ointments, in paste bandages or suspended in water as lotions for the astringent action they exert upon abraded surfaces of the skin. Zinc and castor oil ointment of the British Pharmacopoeia is a well-tried treatment for nappy rash.
Zinc undecenoate is used as an ointment and as a dusting-powder in the treatment of RINGWORM.... zinc
Most casts are made of bandages, impregnated with plaster of Paris, which are applied wet and harden as they dry.... cast
Alternatives. Topical. Tincture Arnica: 5 drops in eggcup of water as a lotion. “In the absence of tincture Arnica,” says Finlay Ellingwood MD, “wipe the discoloured area with Liquid extract Echinacea which stimulates an active capillary circulation and promotes recovery.”
Arnica is never used on open wounds. Calendula (Marigold) is indicated.
Compress: any of the following: Arnica flowers, Chickweed, Cowslip, Hyssop, Black Bryony, Fenugreek seeds, Hemp, Agrimony, Calendula, Oak leaf, St John’s Wort, Linseed, Herb Robert, Sanicle, Rue, Yarrow. Pulped Comfrey root, potato, cabbage leaf or Horsetail.
Lotions, creams, etc. Arnica, Chickweed, Comfrey, Myrrh.
Bruised bones. Comfrey, Rue. Spinal injuries: St John’s Wort.
Others: ice or cold-water compresses fixed by bandages. Weleda Massage Balm. Diet. Yoghurt: to encourage production of Vitamin K – the anti-clot vitamin. Supplements. Vitamins: B-complex, C, E, K, bioflavonoids. ... bruises
BURSITIS. Tendinitis. Inflammation of a bursa – a soft-tissue elastic sac between bones that glide over one another, as in elbow and shoulder. Contains a little fluid, its purpose being to form a cushion against friction. In the knee-joint it is known as ‘housemaid’s knee’; over the hips as ‘weaver’s bottom’, joints becoming red, hot and painful.
Deposits of calcium may thicken walls and form a focus of pressure, causing pain. Relief comes when the swelling disperses or bursts. In the 60-70 age group rupture of tendons is a frequent cause. Bursitis accounts for two-thirds of shoulder pains. Neglected, it may progress to ‘frozen shoulder’ in later life. Teas. Celery seeds, Comfrey leaf, Nettles, Wintergreen.
Tablets/capsules. Prickly Ash, Lobelia, Wild Yam, Helonias.
Alternative formulae:– Powders. Turmeric 2; Prickly Ash 1; Cayenne quarter. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.
Liquid extracts. Equal parts: Black Cohosh, Devil’s Claw, Turmeric. Mix. Dose: 30-60 drops thrice daily.
Tinctures. White Willow bark 2; Prickly Ash bark 1; Wild Yam 1; Capsicum quarter. Mix. Dose: 2 teaspoons thrice daily.
Cider vinegar. 2-3 teaspoons to glass of water 2-3 times daily.
Topical. Apply strapping plaster to arrest swelling. See: FOMENTATIONS. POTATO. BRAN OR COMFREY ROOT POULTICE.
Aromatherapy. Cajeput, Chamomile, Origans, Rosemary. 6 drops of any one oil in 2 teaspoons Almond oil for massage.
Diet. See: DIET – GENERAL.
Supplements. Vitamin A. Vitamin C (3-4g). Vitamin E (400iu). Zinc 15mg.
General. Cold packs. Compression bandages. Gentle massage under the knee where knee joint is involved. For septic bursa add Echinacea to internal medication or apply ointment. For drainage, aspiration is sometimes necessary. Protect knees with knee-pads. Turmeric acquires reputation for relief. ... bush tea
Treatment. If the wound is a small puncture, wash with soap and water and dry. Wipe with distilled extract of Witch Hazel, or with a solution made from 1 teaspoon Tincture St John’s Wort (Hypericum) or 1 teaspoon Tincture Marigold (Calendula) to a cup of water. Cover with clean dry dressing.
Many natural healing ointments are available: Comfrey, St John’s Wort, Marigold, Chickweed, Slippery Elm, Foxglove leaves. In days of the Civil War Comfrey leaves were used as bandages and washed Sphagnum Moss as cotton wool. Leaves or gel of Aloe Vera plant enhance healing and reduce scarring. Bruised leaves of Cranesbill, Bistort, Hyssop.
Literally hundreds of natural substances promote healing and prevent infection, including: Goldenseal, Myrrh, Echinacea, Cinnamon, Pot Marjoram, Chamomile, Fenugreek, Self-heal, Woundwort, etc. The Menominee Indians used the powdered root of Skunk Cabbage for injuries and wounds that refused to heal. (John Bartram, 1699-1777)
To minimise scar formation after healing: wipe with castor oil or contents of a Vitamin E capsule. Honey is a popular domestic application for cuts and grazes “to draw out the dirt”.
Products: Nelson’s Hypercal, Doubleday Comfrey Cream. ... cuts
Avoid overstocking; some herbs lose their potency on the shelf in time, especially if exposed. Do not keep on a high shelf out of the way. Experts suggest a large box with a lid to protect its contents, kept in a cool dry place away from foods and other household items. Store mixtures containing Camphor separately elsewhere. Camphor is well-known as a strong antidote to medicinal substances. Keep all home-made ointments in a refrigerator. However harmless, keep all remedies out of reach of children. Be sure that all tablet containers have child-resistant tops.
Keep a separate box, with duplicates, permanently in the car. Check periodically. Replace all tablets when crumbled, medicines with changed colour or consistency. Always carry a large plastic bottle of water in the car for cleansing dirty wounds and to form a vehicle to Witch Hazel and other remedies. Label all containers clearly.
Health care items: Adhesive bandages of all sizes, sterile gauze, absorbant cotton wool, adhesive tape, elastic bandage, stitch scissors, forceps (boiled before use), clinical thermometer, assorted safety pins, eye-bath for use as a douche for eye troubles, medicine glass for correct dosage.
Herbal and other items: Comfrey or Chickweed ointment (or cream) for sprains and bruises. Marshmallow and Slippery Elm (drawing) ointment for boils, abscesses, etc. Calendula (Marigold) ointment or lotion for bleeding wounds where the skin is broken. An alternative is Calendula tincture (30 drops) to cupful of boiled water allowed to cool; use externally, as a mouth rinse after dental extractions, and sipped for shock. Arnica tincture: for bathing bruises and swellings where the skin is unbroken (30 drops in a cup of boiled water allowed to cool). Honey for burns and scalds. Lobelia tablets for irritating cough and respiratory distress. Powdered Ginger for adding to hot water for indigestion, vomiting, etc. Tincture Myrrh, 5-10 drops in a glass of water for sore throats, tonsillitis, mouth ulcers and externally, for cleansing infected or dirty wounds. Tincture Capsicum (3-10 drops) in a cup of tea for shock, or in eggcup Olive oil for use as a liniment for pains of rheumatism. Cider vinegar (or bicarbonate of Soda) for insect bites. Oil Citronella, insect repellent. Vitamin E capsules for burns; pierce capsule and wipe contents over burnt area. Friar’s balsam to inhale for congestion of nose and throat. Oil of Cloves for toothache. Olbas oil for general purposes. Castor oil to assist removal of foreign bodies from the eye. Slippery Elm powder as a gruel for looseness of bowels. Potter’s Composition Essence for weakness or collapse. Antispasmodic drops for pain.
Distilled extract of Witch Hazel deserves special mention for bleeding wounds, sunburn, animal bites, stings, or swabbed over the forehead to freshen and revive during an exhausting journey. See: WITCH HAZEL.
Stings of nettles or other plants are usually rendered painless by a dock leaf. Oils of Tea Tree, Jojoba and Evening Primrose are also excellent for first aid to allay infection. For punctured wounds, as a shoemaker piercing his thumb with an awl or injury from brass tacks, or for shooting pains radiating from the seat of injury, tincture or oil of St John’s Wort (Hypericum) is the remedy. ... first aid and medicine chest
Atopic eczema is a chronic, superficial inflammation that occurs in people with an inherited tendency towards allergy. The condition is common in babies. An intensely itchy rash occurs, usually on the face, in the elbow creases, and behind the knees. The skin often scales, and small red pimples may appear. For mild cases, emollients help keep the skin soft. In severe cases, corticosteroid ointments may be used. Antihistamine drugs may reduce itching. Excluding certain foods from the diet may be helpful. Atopic eczema often clears up on its own as a child grows older.
Nummular eczema usually occurs in adults. The cause is unknown. It produces circular, itchy, scaling patches anywhere on the skin, similar to those of tinea (ringworm). Topical corticosteroids may reduce the inflammation, but the disorder is often persistent.
Hand eczema is usually caused by irritant substances such as detergents, but may occur for no apparent reason. Itchy blisters develop, usually on the palms, and the skin may become scaly and cracked. Hand eczema usually improves if emollients are used and cotton gloves with rubber gloves over them are wornwhen coming into contact with irritants. If the eczema is severe, corticosteroids may be prescribed.
Stasis eczema occurs in people with varicose veins. The skin on the legs may become irritated, inflamed, and discoloured. The most important factor is swelling of the legs, which may be controlled with compression bandages or stockings. Ointments containing corticosteroids may give temporary relief.... eczema
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