WHAT TO DO IN CASES OF
ACCIDENTS AND EMERGENCIES,
Describing the Symptoms in each Case,
AND
HOW TO TREAT THEM ON THE MOMENT.
WITH
A LIST OF THE PRINCIPAL POISONS,
Which, if taken, require prompt treatment.
Their Remedies and Antidotes.
Designed for
FAMILY AND GENERAL USE.
BY
JOSEPH B. LAWRENCE,
Medical and Surgical Nurse.
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NEW YORK.
J. H. VAIL & CO., 21 Astor Place.
1888.
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ENTERED ACCORDING TO ACT OF CONGRESS IN THE YEAR 1888, BY
JOSEPH B. LAWRENCE,
IN THE OFFICE OF THE LIBRARIAN OF CONGRESS AT WASHINGTON.
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PREFACE.
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The object of this work on “Accidents and Emergencies” is to inform the
general reader of “What to do, and how to do it,” not only in the first
instance, but in those cases where professional assistance cannot be
readily obtained, and in language that any person of ordinary
intelligence can understand and apply.
Accidents both on land and water are of common occurrence and may happen
to any of us. To know what should be done at once in our efforts to
assist others in accidents that might have occurred to ourselves is a
part of our duty to our neighbors; though the necessary presence of mind
and capacity to use that knowledge is not in the power of any work to
supply.
Should this work prove the means of having alleviated pain and assisted
the subsequent professional treatment in restoring the sufferer to
health, the author’s hopes will have been realized and his labors
repaid.
J. B. L.
265 West 43d Street, November 1st, 1888.
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CONTENTS.
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PAGE.
Accidents and Emergencies 7
Accidents. How to avoid them 123
Accidents on the Water 11
Apoplexy 12
Asiatic Cholera 15
Broken Bones—Fractures 19
Bruises 30
Bleeding from the Nose 31
Bleeding from Cut or Wound 33
Burns and Scalds 34
Catalepsy—Trance 37
Choking 39
Cholera Morbus 40
Clothes catching Fire 42
Colic 43
Concluding Remarks 128
Cramps 51
Diarrhœa—Looseness of the Bowels 52
Dislocations 56
Drowning 61
Effects of Cold—Frost Bites 64
Epilepsy—Epileptic Fits 67
Fainting Fits 72
Fish-Hooks, Crochet Needles, Thorns,
Splinters, etc., in the Flesh 73
Fits—Convulsions 75
Foreign Bodies in the Gullet 78
Foreign Bodies in the Windpipe 79
Foreign Bodies in the Ear 80
Foreign Substances in the Nose 82
Hydrophobia—Rabies 84
Lockjaw 86
Paralysis—Palsy 87
Poison—Ivy 91
Poisons 91
Poisons and their Antidotes 93
Presence of Mind. Take Things Quietly 125
Sea Sickness 99
Snake Bites 102
Sprains or Strains 104
Stings of Insects 107
Suffocation 108
Sunstroke 110
Things in the Eye 113
Tooth-ache, Pains in the Face and Jaw,
Ear-ache 114
Wounds 116
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ACCIDENTS AND EMERGENCIES.
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The present work has been undertaken in the belief not only that it will
supply a want felt by those who have had no surgical education and
training, and are by circumstances placed where professional skill and
assistance cannot readily be had, but also in the desire of imparting to
such a general knowledge of the nature, course of treatment, and
ordinary results of such accidents and emergencies that are of common
occurrence and a description of which has ordinarily to be sought in
technical works intended for professional readers and understood with
difficulty by others.
Accidents, (_a_, from cadere, to fall,) are events that happen suddenly,
and are beyond man’s foresight and control.
Emergencies, (_e_, from mergere, to plunge), taken in this connection
are conditions, or connection of circumstances calling for prompt action
and a ready resource. Colic, Cholera, Diarrhœa, etc., cannot, strictly
speaking, be regarded in the light of accidents, but the suddenness of
such attacks lends them all the gravity that attaches to “Accidents.” In
this sense, the terms “Accidents and Emergencies” have been coupled
together as the title of this work, and in which they have been treated
in the following pages. Life is beset with possible perils. Infractions
of the moral, no less surely than those of the natural law, bring
punishment which ignorance and selfishness invite. But there are dangers
to which we are exposed through causes beyond our control. In such
cases, presence of mind, and the power of taking things quietly, is of
the chiefest importance. “Old women of both sexes,” who give way to
their feelings by hysterical screams, or even hinder those who know what
to do, not only complicate matters, but are a nuisance that should at
once be removed. In such cases it is doubly true that “he who ruleth his
spirit is greater than he who ruleth a city.”
* * * * *
Not every one can preserve the requisite coolness and decision of
character, when suddenly called upon to do so; but there are some who
can master their own feelings and overcome the natural dread of blood
and pain sufficiently to forget self in those larger and nobler feelings
evoked by that “one touch of nature which makes the whole world akin.”
* * * * *
With these few brief introductory remarks I will proceed to consider the
immediate effects and treatment of such Accidents and Emergencies as are
of ordinary occurrence, namely:
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Accidents on the Water.
Many such occur yearly, and much loss of life and personal injury can be
prevented by exercising a little common sense and self-possession. If
swamped or overturned in a boat, and unable to swim, your chief endeavor
must be to keep your head above water. This is easily done if you will
simply throw yourself on your back, lying perfectly still, just moving
the _hands_ to and fro on the water, in the same level with the body. Or
else fold the arms over each other, keeping them some little distance
from the body, the latter being in a perpendicular position, instead of
a horizontal one, as in the former case. When on board a vessel that has
been run down, do not crowd round the boats and thus hamper the efforts
of the sailors, nor to that side to which the vessel lists. The story of
the “Birkenhead” shows what discipline and coolness will do in saving
human life.
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Apoplexy.
Apoplexy may be defined as the sudden deprivation of all the vital
functions, save those of the heart and lungs; though feeling and will
are at once suspended, and in an instant, and often without any
premonitory warning, a person in apparently robust health falls down in
a state of insensibility, and as if in a deep sleep, stricken down by
the sudden blow. One form of the attack is, (A) where the face becomes
flushed, the breathing heavy, and the pulse full and not frequent with
occasional convulsions. But the attack may be preceded, (B) by a sudden
pain in the head accompanied by faintness and vomiting; the skin becomes
cold, and the pulse feeble, and at times convulsions follow. The patient
may fall to the ground, but will revive for a while and recover from all
these symptoms, though the headache will continue, and then by degrees
he becomes heavy and forgetful, and his ideas wandering and
disconnected, till at last he sinks into a state of stupor from which
there is no recovery. This form of attack, though less alarming, at the
beginning, to those present, is more dangerous than the one previously
mentioned. The tendency to these attacks increases with advancing years,
and more generally between the ages of 45 to 60, and to persons of
square stout build, with short necks and large heads, though their
opposites physically are by no means exempt. Men are more liable to
apoplectic attacks than women; youths and children rarely suffer from
them. Apoplexy may be _cerebral_—that is, arising from congestion or
rupture of the brain; or _pulmonary_, due to hemorrhage of the
parenchyma of the lungs. The _first_ is the commoner form. The attack
may be sudden and violent, or comparatively slight at first and
progressive in intensity; or it may commence with apoplexy terminating
in paralysis, or commence with the latter and terminating with the
former.
CAUSES. Apoplectic attacks are due to constitutional predisposition or
exciting causes, among which may be mentioned sex, age, bodily
conformation—all of which have already been touched upon above.
Excessive mental anxiety and exertion, such as business troubles, or
extreme emotions or passions; too free indulgence in either eating or
drinking, especially by persons of advanced years; severe bodily or
mental strain, in fact, whatever produces a tendency to quicken the
circulation of blood to the head, or retards its return from it.
TREATMENT. When the symptoms are such as described in the first form
(A), immediately place the patient in a recumbent position, with the
head and shoulders raised, remove everything about the neck and loosen
the clothes. Admit the air freely, and apply ice—if obtainable—or cold
wet clothes to the head, changing them frequently. In the second set of
symptoms mentioned, (B), raise the head and shoulders, loosening the
clothes, and removing whatever presses on the neck, applying ice, etc.,
as set forth above; but the patient’s skin being cold and the pulse
small and fluttering, apply strong spirits of ammonia to the nostrils
and hot flannels to the legs, and hot water-bottles to the feet, or put
the feet into warm water with a little mustard. Then, if the sufferer is
able to swallow, administer slowly from 15 to 20 drops of aromatic
spirits of ammonia in a half glass of water, or one-half dram of
aromatic spirits of ammonia in one and one-half ounces of camphor
mixture. Purgatives should be given as soon as possible, 10 grains of
calomel placed on the tongue, followed by a black draught; or 2 or 3
drops of croton oil rubbed on the back of the tongue, and an injection
given composed of two table-spoonfuls of common salt with a little
butter; or a pint of warm water; or an injection composed of soap suds
and four ounces of sweet oil. If the attack be after a heavy meal, an
emetic should be administered of a scruple of sulphate of zinc with a
grain or two of tartar emetic. To guard against future attacks, mild
tonics should be taken, the body daily washed and rubbed and the bowels
kept well regulated. It is hardly necessary to add that on any occasion
of an attack a physician should at once be called in.
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Asiatic Cholera.
This terrible disease is of a very violent and sudden character. It
attacks a person without any warning, and generally within a few hours
leaves him—a corpse.
CAUSES. The actual cause is not well determined, but the effects are
most disastrous in crowded towns and cities where dirt and disregard of
sanitation prevail. Impure water, improper food, indulgence in sensual
habits, and intoxicating beverages, or whatever tends to weaken and
undermine the constitution, are all so many invitations to a visitation
of this dire disease. Fear, especially when the epidemic is present in
the district, is also a not infrequent cause.
SYMPTOMS. The attack of the commencement is marked by derangement of the
digestive organs, want of appetite, pains in the loins and knees,
thirst, and looseness of the bowels; then follow sickness and
purging—the discharges having the appearance of rice water, very unlike
those presented in diarrhœa, or bilious purging—accompanied by severe
and painful cramps in the calves of the legs, and afterwards in the
bowels, stomach, and other parts of the body, which becomes bent, with
the limbs twisted. The thirst is intensified, the breathing hurried and
difficult, with a hardly perceptible pulse. The eyes are sunken and
surrounded by a dark rim, and the skin is cold and clammy; there is a
feeling of intense heat in the stomach accompanied by violent thirst.
The patient is entirely prostrated, and sinks into a state of apathy,
from which, unless a change very speedily takes place, he never
recovers.
TREATMENT. Although the writer has met with a case where the patient
recovered when all hope had been abandoned; still when once the disease
has taken hold of a person, it is very seldom indeed that he is ever
again restored to health. There is no known cure, or any proper course
of treatment to be followed, agreed upon by medical men whose views of
how this disease should be treated, have of late years undergone
somewhat of a change. The time when a cure is most likely to be effected
is at the initial stage. Put the patient to bed, and apply hot bricks
and fomentations to the extremities and mustard plasters to the bowels,
the looseness of which should receive prompt attention. Five to ten
drops of laudanum, repeated a few times every three hours, will
generally put a stop to this. Dr. Watson[1], however, expresses as his
opinion, “that the one important and guiding rule of treatment is not to
attempt by opiates or by other direct repressive means to arrest a
diarrhœa while there is reason to believe that the bowels contain a
considerable amount of morbid and offensive materials. The purging is
the natural way of getting rid of the irritant cause. We may favor the
recovery by directing the patient to drink copiously any simple diluent
liquid—water (cold or tepid), toast-water, barley-water, or weak tea;
and we may often accelerate the recovery by sweeping out the alimentary
canal by some safe purgative and then, if necessary, soothing it by an
opiate.” The diet should of course be very carefully regulated, and more
sparingly partaken of than in health, but not particularly changed
except to abjure all food known to be indigestible and injurious. When
the patient reaches the stage of purging, vomiting and cramps, the
treatment must be energetic. The failing powers must be sustained by
chloroform, opium and ammonia, or camphor, opium and cayenne. Brandy may
also be freely administered and the warmth of the body promoted by all
possible means. These remedies should be energetically pursued,
especially the stimulants, and the efforts to promote warmth in the
surface, until the final stage of prostration and apathy is reached.
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Broken Bones.—Fractures.
Falls, and other trifling accidents occasioning the breaking of some
bone or other, are among the commonest incidents of life, (particularly
in the cold weather, when the bones are more brittle than at other
times), often occurring when surgical aid cannot be immediately
obtained. The fact that a bone is broken is easily detected by the
inability to raise the limb, or from its being bent, shortened, or
twisted, as also from the pain. Much additional suffering may be spared
the patient, and increased mischief prevented by the exercise of a
little care and judgment.
The limbs should be tied together, or placed as near as possible in a
natural position, and the patient laid on a door or hurdle, covered with
straw, blankets, etc., upon which he should be laid as gently as
possible and carried to the nearest house. If no hurdle, etc., be
available, a convenient frame can be readily extemporized by tying
firmly two short poles across two long ones, and laying upon these a few
planks, covered with straw or clothing, etc.; or, a blanket securely
attached to the four corners, like a cot-bed, will adequately fulfill
the end in view. In dealing with the treatment, we will commence with
the head, working down to the extremities.
HEAD. All injuries sufficiently severe to break any bones in the head or
face, or to produce insensibility, are especially dangerous, and need
immediate skilled attendance. The head should be raised and cold water
applied, particularly if there be any bleeding, and the sufferer kept as
quiet and free from excitement as the circumstances will permit.
COLLAR BONE. This bone runs from the top of the breast bone to the
shoulder. This fracture is perhaps one of the most ordinary accidents
that can happen, as it is also one of the most readily detected. It
generally occurs about the middle of the bone, and is commonly caused by
falling upon the arm or shoulder. The fracture will be noticed by a
lump, the broken bones rising one above the other, with considerable
pain and tenderness in the injured part, and inability to raise the arm.
The principal object is naturally to keep the shoulder back so as to
facilitate the union of the bones. The most simple and efficacious way
for non-professional persons to effect this, is the following. Make a
round pad of some soft material, about five inches long and thick, and
wrap it in a small shawl. Push the shoulder backwards, pressing the
fracture with the other hand, till you get the bones back into their
proper place. Now place the pad well under the armpit on the injured
side, bringing the ends of the shawl back and front over the opposite
shoulder, then crossed and tied under the sound arm. The sore arm should
be well supported in an ample sling, extending from the elbow to the
wrist. A surgeon should then be seen to set the fracture right. If there
be a tendency to swelling, the arm will require to be bandaged from the
fingers upwards.
BROKEN RIBS are generally due to a fall or blow affecting one or more of
the bones. A sharp pain is experienced, which is intensified when taking
a deep breath or coughing, and by placing the hand upon the injured part
a grating sensation will at the same time be felt. A possible injury to
the lungs from the sharp points of the fractured rib, and the consequent
inflammation, is the chief danger to be apprehended from this accident.
If there should be any spitting of blood, the patient must be kept
perfectly still, and no stimulants given him. A piece of some stout
material, from 8 to 10 inches wide, should be bound tightly round the
chest several times to prevent the rise and fall of the ribs in
breathing, commencing as near as possible to the armpits, down to the
pit of the stomach.
If there be a bruise, apply hot fomentations, hot plaster, or hot
bran-bags. Should there be any inflammation, the patient must be kept to
his bed, resting in that position which affords him the greatest
comfort, and restricted to a low diet. The pulse must be quieted by
administering a dose of from 3 to 5 drops of tincture of American
hellebore (veratrum viride) every one or two hours in a little sweetened
water, and gradually increasing till the pulse comes down to about
seventy. If the accident occur away from the house, bind some
substantial substance tightly _over the clothes_, until the sufferer can
be conveyed home. In all cases of a wound to the chest, the person must
lie on the _wounded side_.
ARM. _Above the elbow._ A fracture of the humeral, or upper arm bone,
occurs most generally about the middle, but less commonly within an inch
or so of the extremities. It can be readily detected by taking hold of
the arm, just above and below the suspected fracture, and trying to
bring the upper and lower portions together, when the broken ends can
easily be felt, and a _grating_ heard as they rub against each other.
The injured limb is bent and helpless, and if the bones overlap each
other _shortened_. The arm should be pulled gently and gradually to its
natural length, the operator in the meanwhile setting the bone, and a
bandage applied, but not too tightly, from the shoulder to the elbow.
Over this bandage, four splints, well padded with lint or wadding and of
the same length as the bandage, should be placed, one in front, one
behind, and one on either side of the broken bone. The splints should be
furnished with tapes to tie or buckle. The arm must be confined to the
side, and the hand and fore-arm carried in a sling. The dressing should
be removed in a week or ten days, to see that all is right and proper
progress made.
ELBOW. In this instance, though the patient is able to bend, he cannot
straighten his arm, which when moved backwards and forwards makes a
grating sound and gives intense pain. Falls or blows are the usual
causes producing this fracture. The point of the elbow seems gone, being
drawn into the back of the upper arm. Apply leeches and evaporating
lotions to reduce any inflammation that may be present. When this is
done, straighten the arm and bandage carefully from the fingers to the
joint, and set the broken bone, continuing the bandage, passing it over
and above the injured part. A well padded splint, extending from the
hand to nearly the shoulder, should now be applied on the inner side and
a similar one on the outside of the arm. The joint must be rested from
four to five weeks, removing the splints some three or four times during
that interval to ascertain that the skin is not being chafed, nor the
bone disturbed.
ARM _below the elbow_. In the upper arm we have but one bone, but here
there are two: one running from the elbow to the wrist at the end of the
little finger, and the other on the side next the thumb. When both bones
are broken the fracture can be readily detected, but not so when only
one is broken, as the sound bone assists to keep the other in place, and
the injury is not so easy to discover. In a fracture of the outer and
thicker bone (ulna), the arm seemingly retains its normal shape, though
broken at the elbow or some other part of its length. In this case the
elbow should be bent and the hand turned upwards, as if to lay it flat
on the chest. Then apply two splints, placing one on the palm of the
hand reaching to the bend of the arm, and the other, and outer one, from
a little beyond the elbow to about the knuckles. The arm should be well
raised towards the chest, so as to keep the outer from the inner bone
(radius). When the fracture occurs in this inner bone, the same
treatment must be observed, with this one exception: that to ensure the
bones being kept apart, the hand must be _lowered_ instead of raised.
When both bones are broken, the operation is naturally a more difficult
one and requires skilled attention. In bandaging fractures, due
allowance must be made for swelling, which is present during the first
two or three days.
HAND, WRIST, or FINGER.
HAND. Fracture of the _Hand_. An accident to these bones, which lie
between the wrist and the fingers, should be treated in the following
way. Place in the palm a ball of small but firm material, or a ball of
newspaper rolled tightly, closing the thumb and fingers tightly over it,
and bandaging them in that position to preserve the natural arch, which
the application of flat splinters will not do. The arm should be
supported in a sling from four to five weeks to permit the bones to
re-unite.
FINGER. Fracture of the _Finger_. After gentle extension and
counter-extension to bring the broken parts together, and having
attained that end, apply narrow pasteboard splints or small pieces of
gutta-percha on the upper and lower sides and bandage sufficiently tight
to keep the finger in an extended position. The arm should rest in a
sling from four to five weeks; and if any swelling occurs, the bandage
must be loosened and cooling lotions applied.
WRIST. Fracture of the _Wrist_. In a fracture of the wrist bones apply a
splint front and back and tie a bandage firmly round from above the
injured part to nearly the tips of the fingers. The arm should be
supported in a sling till such time as it can be prudently dispensed
with.
HIP JOINT. In such accidents, to which elderly people are more
particularly liable, the sufferer should be as soon as possible placed
in bed, and after carefully removing his clothing, the doctor sent for.
THIGH. The fracture of the thigh bone is an accident of a very grave
character, though easily discerned by the inability to raise the leg and
the consequent pain in attempting to do so. The chief difficulty in this
case is to obtain a proper union, for the violent spasms of the muscles,
acting lengthwise, cause the fractured parts to overlap each other,
occasioning much suffering. This is especially the case when the
fracture is an oblique one. A long straight splint is the best to use,
lightly bandaged at first and gradually tightened to accustom the limb
to the pressure. If the accident occur away from home, bind the injured
limb with a temporary splint, made of very thin boards or stiff straw,
or with a felt hat, cut into long slips and secured by neckcloths,
handkerchiefs, etc., over the fracture. On getting the sufferer home to
bed, if the spasms be severe, apply a bandage around the ankle and over
the instep and attach a weight of eight or nine pounds, letting the foot
hang over the edge of the bed. This will give the patient much relief.
KNEE-PAN. This fracture may be either up or down, or across, but more
commonly the latter, and is generally due to a fall, or as is sometimes
the case, from a violent muscular exertion in throwing out the leg. The
sufferer loses all natural support from the limb. The treatment should
in the first instance be directed to reduce any inflammation that may be
present by applying tincture of arnica, leeches, or lotions. Then
_straighten_ the leg and apply a well padded splint behind to prevent
any movement of the knee. The patient should be in a half-sitting
posture, with the leg well raised above the level of the hip. Apply a
bandage over the splint, commencing half-way up the thigh, extending as
far as the fractured knee-pan; above and below the knee the bandage
should be drawn tightly to prevent the broken bone from slipping under
it. The broken bones should now be brought together and a bandage passed
several times above and below the knee to assist the union of the bones.
If the patient is obliged to move, the leg should be well supported by a
firm bandage passing round the neck and under the foot, lifting the
latter well off the ground.
LEG. The leg is that part of the limb between the knee and ankle, and
here again, as in the fore-arm, there are two bones, the smaller one
(fibula) on the outside, and the larger one, the shinbone (tibia), on
the inner and front side. A fracture of the former is not easy to find,
and it is not very material to do so, as the shinbone will act as a
natural splint. But if this too should be broken, it is impossible to
walk upon the limb, which loses its shape and becomes bent, while the
broken portions may be felt or heard grating against each other. The
treatment is the same as in other fractures. That is, bring the broken
portions together by extension and counter-extension. Then apply two
splints, one on the outer side, from the knee to about four inches below
the sole of the foot, and the other upon the inside, and over these use
a bandage extending from the toes to the knee. The leg may rest on any
side most agreeable to the patient. The dressing can be removed in about
a week’s time to ascertain if the bones have joined properly. A month,
at least, must elapse before the dressing can be dispensed with, and
even then the leg must be used gradually and with great care.
ANKLE and FOOT. Fractures in these cases require similar treatment as
those which happen to the hand and wrist. These accidents, which are
serious, are often accompanied with lacerations of the flesh and
ligaments. Pasteboard splints should be used, and in case of any matter
forming, it should at once be released.
---------------------
Bruises.
It is unnecessary to describe these results of accidents, with which we
are all familiar in a greater or less degree from our childhood. They
are easily caused and as easily cured when the injured person is in the
enjoyment of ordinary good health. When the skin comes into contact with
some substance harder than itself, the softer substance naturally
receives an injury more or less severe (called a _bruise_), producing a
rupture of a number of tiny blood vessels under the skin, giving it the
appearance of “black and blue.” The _treatment_ is simple; the chief
object being to prevent inflammation. Bathe the injured parts with cold
water, or equal parts of Goulard water and vinegar. Or apply a lotion of
one part of tincture of arnica to eight of water.
---------------------
Bleeding from the Nose.
Do not, unless it be violent, interfere with a bleeding from the nose. A
bleeding from the nose is frequently an effort of Nature to relieve
itself, and therefore, unless it be likely to weaken the patient, ought
not to be restrained. If it be necessary to restrain the bleeding, first
ascertain whether the blood escapes from both nostrils, or from the
right or left. Press the nose firmly for a few minutes between the thumb
and forefinger; this alone will often stop the bleeding. If it should
not, inject with a syringe a quantity of ice-water or a solution of
common salt, in the proportion of one table-spoonful to half a tumbler
of water; or a piece of lint, twisted and moistened with the solution,
may be forced up the nostril and allowed to remain until the bleeding
ceases.
If these plans fail, then try what bathing the nose and the forehead
with water quite cold and plunging the hand and the fore-arm into cold
water for a few minutes will do. Then take them out and raise the arm
above the head. The arm is raised to distribute the force of the heart’s
action and to take the pressure off the carotid vessels, diminishing the
strength of the current through them. This plan has frequently succeeded
when others have failed. When the blood comes from laceration of the
naso-palatine artery, all these measures are apt to fail and the
posterior nares must then be plugged. The operation of plugging is
simple, and does not require a great amount of skill. It may be
performed with a gum-elastic catheter, (No. 4 or 5 will do). Through the
eye of the instrument pass a string, allowing the ends to hang down.
Introduce the catheter through the nostril into the mouth and draw the
string, which is hanging from its end, out beyond the lips. To this
attach a piece of sponge sufficiently large to fill up the opening in
the posterior nares, completely filling its cavity. This method scarcely
ever fails to control the most obstinate bleeding.
---------------------
Bleeding from Cut or Wound.
If bleeding occur from any part where a bone lies near the surface, as
the head or face, it may generally be stopped by pressing firmly against
the bone with the finger or a piece of cork, or by binding on tightly a
hard pad. If this does not succeed, lift up each edge of the wound and
examine carefully to see if any small stream of blood is spouting out in
jets. If so, an artery is wounded, and the point of small forceps or
tweezers must be dipped in where the jets come from, the spouting mouth
taken hold of and drawn out, and a strong silk thread passed round it
and tied below the forceps. The white and gaping mouth of the vessel may
then be seen.
If the bleeding be profuse from an arm, the whole current of blood to
that limb must be cut off, which may be done by some person pressing a
thumb firmly into the neck behind the middle of the collar bone. This
will dam up the blood in the great artery of the arm as it comes out of
the chest. The handle of a door-key, wrapped in several folds of linen,
may be pressed upon the place for a long time until medical assistance
can be had. Dangerous bleeding from the thigh or leg may often be
stopped by pressing the great artery just below the crease of the groin.
If the bleeding be below the middle of the upper arm, or middle of the
thigh, pass a handkerchief once or twice around the limb, as far above
the wound as possible, and tie it loosely. Slip a stiff stick under this
and turn it round, like the handle of an auger, until the handkerchief
becomes so tight as to stop the bleeding. The tight bandage tied round
the limb may be an injury if long continued. Let there be no delay in
sending for the doctor.
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Burns and Scalds.
A burn is the effect of concentrated heat acting upon living tissues.
The effects are inflammation and sometimes complete disorganization and
destruction of the parts.
A scald is an injury produced by applying hot water or other fluid to
the skin or mucous membrane. The natural temperature of the human body
is ninety-eight degrees; that of boiling water two hundred and twelve
degrees. Bringing the skin in contact with a fluid heated so far above
it, produces redness and pain, and when nothing is done instantly to
ward off the injury, the scarf skin is raised from the true skin in the
form of a blister filled with water.
The degree of danger from a burn or scald depends upon the extent of the
injured surface and also upon the depth of the injury. An extensive burn
or scald may prove fatal in a few hours, the patient never rallying from
the first prostration. These injuries are most dangerous when upon the
head, neck, chest and belly. Old persons, and those who are feeble and
have shattered constitutions, will sink under burns and scalds from
which robust persons will suffer but little.
In simple burns which do not involve the true skin, very little
treatment is necessary.
Prepared lard, that is to say lard without salt, is an admirable remedy
for burns and scalds. All that has to be done is to spread the lard
either on pieces of old linen rag or on lint and then to apply them
smoothly to the parts affected, keeping them in their places by means of
bandages.
Another valuable remedy for burns is carron oil, which is made by mixing
equal parts of linseed-oil and lime-water in a bottle, and shaking it up
well before using it.
When the true skin is partially or completely destroyed, a thick layer
of flour may be placed over the burned surface and covered with cotton.
I have seen the best results from the employment of flour and carron
oil, and prefer them over all others for loosening the flour when it is
to be taken off. Poultices are useful. Whatever dressing is employed, it
should not be disturbed until separated by the exudation underneath, or
unless foul odors arise. In changing, every particle should be carefully
removed and the parts thoroughly washed with some disinfectant liquid,
such as solution of carbolic acid, 1 to 80.
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Catalepsy.—Trance.
Catalepsy, or what is more generally known as trance, is a sudden
spasmodic suspension of the senses of volition, in which the limbs
become rigid, preserving a fixed position, no matter how uncomfortable
or painful. The patient retaining exactly the same attitude as when
seized, and if during the attack the position of the limbs be varied,
they will remain as placed. The mind is apparently so absolutely
engrossed in something outside of the person, that all control over, and
union with the body seems lost, leaving it as it were dead; but after
the paroxysm has passed there will generally be no recollection of what
has transpired during the time that consciousness was suspended. In this
respect persons in a cataleptic fit resemble those in a mesmeric state,
or in the condition of insensibility produced by inhaling ether or
chloroform. A peculiarity of this disease is that the thread of
conscious life is taken up at the very point it was interrupted by the
attack. An incomplete act will be completed; an unfinished sentence
concluded at the end of the fit, though it should last for several
minutes or perhaps hours.
CAUSES. The causes of this disease, to which women are more liable than
men, are rarely local, but such as influence the whole body; catamenia,
painful mental emotions, worms, an impaired digestion, may be cited as
amongst the principal. Sometimes these attacks terminate in apoplexy,
epilepsy, or melancholia.
TREATMENT. This must depend upon the probable cause of the disease. If
the patient be of a full habit, cupping at the back of the neck,
blisters, a seton or an issue, and purgatives should be given. But if in
a weak, low state tonics and medicines to allay the spasms must be
administered. During the attack mustard plasters should be applied to
the hands and feet and pit of the stomach. Should the fit be a
protracted one, cold water must be dashed over the head and face and
strong ammonia applied to the nostrils. The following liniment may be
beneficially used along the spine once a day: oil of hemlock, 2 drams;
oil of vriganum, one dram; camphor, one dram; alcohol, 5 ounces. On
recovery the patient should have nourishing diet, moderate exercise with
sea bathing, or cold shower-baths. Mild tonics should also be taken to
strengthen the system.
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Choking.
Some children eat much too fast; they bolt their food rather than eat
it; if not carefully watched fill the mouth so full and swallow lumps of
food in such hot haste as to choke themselves. Instantly put your finger
into the throat and feel if the substance be within reach. If it is
food, force it down, and thus liberate the breathing. Should it be a
hard substance, thrust the finger and thumb as far back into the throat
as possible, and if there be anything there attempt to pull it out at
once. Whilst you are doing this, sometimes a violent fit of coughing
will take place and expel it. If you cannot reach it give a good smart
blow with the flat of the hand on the back just below the neck, which
will often relieve the windpipe when obstructed. If that does not have
the desired effect, tickle the throat with the finger so as to ensure
the immediate vomiting and the subsequent ejection of the offending
substance. Of the treatment of things that pass down at once into the
stomach, such as pieces of money, buttons, and many articles of a like
kind, which children, playing with frequently put into their mouth and
sometimes swallow, little need be said, for they are seldom followed by
any serious consequences. Sooner or later the foreign body passes
through the alimentary canal with the food, and is thus got rid of. I
may add, however, that in this case it is a very common practice to give
repeated doses of aperient medicine; now unless the bowels should become
confined, such a measure is rather injurious than useful.
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Cholera Morbus.
This disease is very apt to make its appearance in the night, and is
very common during the prevalence of warm weather. It is also known as
Bilious Cholera from the great amount of bile secreted and discharged.
CAUSES. These are principally due to excessive heat, especially in
malarial districts, and sudden atmospheric changes; but dampness and wet
feet will also tend to produce an attack.
SYMPTOMS. The disease, which commences with sickness and distress at the
stomach, is followed by violent griping with severe cramps, especially
in the bowels, attended by vomiting of a thin dirty, yellowish, whitish
or greenish fluid, with discharges similar to that vomited. The nausea
and distress generally continue between the intervals of purging and
vomiting, at the same time the pain is intense. The pulse is rapid, soon
becoming feeble and small, the tongue is dry, the urine highly colored.
There is great thirst, yet at the same moment the skin is cool, but no
drink can be retained on the stomach. The bilious discharges, which
characterize this disease, distinguish it from diarrhœa.
TREATMENT. Put the patient to bed, and apply a large mustard plaster
over the stomach and liver. Give liberal draughts of warm water, or
flax-seed tea, which will clear out all the solid contents of the
stomach and bowels. Then every half hour administer a tea-spoonful of
compound powder of rhubarb and potassa, adding to each dose 5 to 10
drops of laudanum if necessary, until the vomiting and nausea are
checked. Or else 10 drops of laudanum and 10 of spirits of camphor after
each evacuation. To promote warmth of the body and of the stomach is of
primary importance in this disease. Warm injections must be given
frequently and hot bricks applied to the feet, while the whole body
should be enveloped in warm flannels. The following is a valuable remedy
in this disease, as also in diarrhœa: Syrup of orange peel, one ounce;
acetate of morphia, 2 grains; tincture of cinnamon, 6 drams; tincture of
cardomum, 6 drams. Mix, and give in doses of one tea-spoonful.
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Clothes Catching Fire.
It is perhaps unreasonable to look for presence of mind when this
frightful accident occurs. Yet it is never more needed than at such a
time. If you continue on your feet, the blaze will rapidly ascend and
increase the chances of the chest being burned and of the flames being
inhaled. If you run to and fro to seek relief from others not present,
you will create a current of air that will fan the flame into a swifter
work of destruction. The instant persons perceive their clothes to be on
fire and in a blaze, they should slip off a coat or shawl and seize the
nearest piece of carpet, large rug, cloths, blanket, cloak, or any other
article, and wrapping them tight around you, throw yourself flat and
roll over and over on the floor. If you do this with energy and
effectually, you will put out the fire instantly. If it be a child or
other person that is on fire, let any person present treat it in the
same way. If the person is badly burnt before the fire is extinguished,
as quickly as possible dash plenty of water upon it to prevent the burns
from becoming deeper.
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Colic.
There are several varieties, arising from different causes, of this
complaint, more commonly known as _gripes_, which are marked by severe
pains in the parts about the navel, with distension or flatulence, but
without purging or looseness of the bowels, and accompanied in some
cases with nausea and vomiting.
CAUSES. Worms, cold, superabundance of vitiated bile, over-indulgence in
indigestible or unripe food, or taking copious draughts of water on an
overheated stomach, are among the principal causes which produce this
malady, of which there are some seven distinct kinds recognized by
medical men, the commonest forms of which we will now proceed to
describe.
WIND OR FLATULENT COLIC.
This is a severe and distressing pain in the bowels, with sometimes a
stoppage and swelling about the pit of the stomach.
The CAUSES are due to weakness in the digestive organs, eating
indigestible food or unwholesome fruit, costiveness, and cold.
SYMPTOMS. There is a sense of fullness about the lower part of the
stomach, accompanied with more or less pain, the wind—which is a
characteristic of _this form_ of the complaint—moving from one part to
another of the bowels, making a sort of rumbling noise. Pressure does
not increase the pain as in the case of inflammation. The pulse is
quick, and there is a slight fever attended with nausea.
TREATMENT. If the pain be caused by having eaten of anything
indigestible, the stomach should at once be relieved by administering an
emetic. If this does not have the desired effect, a dose of salts, salts
and senna, or sweet tincture of rhubarb may be given. At all events the
irritating substance must be expelled before the pains will subside. If
there is no sickness of the stomach, a little essence of peppermint in
water, or ginger in hot water, or brandy and hot water may be sufficient
to expel the wind and give relief. If there be costiveness and the pain
continues, the bowels should be moved by stimulating _injections_.
The following is well recommended. Castor oil, one ounce; salts of
tartar, one-half ounce, and hot water, one pint. Mix well together.
BILIOUS COLIC.
This is a dangerous disease, and may be due to a morbid condition of the
liver. The pain, which is chiefly about the navel, but sometimes extends
over the whole body, is of a griping, tearing, twisting nature.
CAUSES. The disease may be due to long exposure to the cold, a torpid
liver and skin, irritating substances taken into the stomach, vitiated
bile, great unnatural heat with dampness, or malaria in the atmosphere,
since it more commonly occurs in the autumn after a hot season.
SYMPTOMS. It comes and goes in paroxysms. Sometimes the abdomen is drawn
in, at other times it is distended and stretched like a drum-head. The
pain can, at the first, be relieved by pressure, but after a while the
belly becomes tender to the touch. There is a thirst and heat and a
discharge of bilious matter from the stomach. In the worst cases the
pulse is small, the face pale, the features shrunken, and the whole body
is covered with cold sweat. While the head is hot, the feet are cold,
and in the advanced stages of the disease the action of the bowels is
sometimes reversed, the feces being forced up through the mouth.
TREATMENT. Administer immediately an active purgative injection. Mix
together four grains of pulverized camphor, 12 grains of cayenne, and
one scruple of white sugar. Divide into four powders, and give one every
fifteen minutes. This will relieve the pain. At the same time cover the
whole belly with a large mustard poultice. The sickness of the stomach
may be allayed by effervescing draughts, to which from 10 to 25 drops of
laudanum have been added; or by hot draughts, with a like quantity of
laudanum over the stomach and feet. A strong decoction of yam-root,
drank freely, is a valuable remedy for relieving the intestinal spasms.
Croton oil, given in one-drop doses done up in crumbs of bread, will
often act as successfully as a purgative medicine; or castor oil and
spirits of turpentine, in equal parts, in two large spoonful doses, may
be taken before trying the croton oil. A warm bath and hot water
bottles, or hot bricks rolled in flannel applied to the feet and sides,
are good for inducing perspiration. Hot fomentations to the bowels
should also not be forgotten.
Persons subject to this complaint may derive great benefit by taking
after each meal one pill of the following recipe: extract of high
cranberry bark, one scruple; cypridia, one scruple; aletridia, one
scruple; pulv. cayenne, one scruple. Mix and make into pills. A sponge
bath, rubbing the body well after it, should be taken daily, and also a
reasonable amount of out-door exercise, without undue exposure to the
sun.
PAINTERS’ COLIC.
Painters’ colic, known also as Devonshire colic, but more generally
under the former designation, affects principally those engaged in the
manufacture of white lead, or who employ it in their trade for mixing
colors.
The name fully explains the CAUSE, which is due to slow absorption of
the carbonate of lead into the system through the lungs, stomach and
skin.
The SYMPTOMS of lead poisoning are, _as a rule_, gradual. The appetite
becomes impaired, and there are transient pains in the umbilical parts,
accompanied by languor, nausea, belching, obstinate costiveness, and
vomiting of acrid bile. The attack which is paroxysmal in its nature,
may be severe, or so mild as not to merit any notice, but by degrees the
pains increase in severity and have a twisting character. The edges of
the gums have a bluish tinge, and the belly becomes hard and contracted
and tender to the touch. The pain, which may lessen at times, but never
wholly leaves the patient as in other forms of colic, will in severe
cases mount up to the chest, and down the arms, even affecting the
bladder, making the passage of the urine painful. The face becomes pale
and contracted, and a cold sweat suffuses the body.
TREATMENT. To relieve the pain and open the bowels, much the same course
should be adopted as in Bilious Colic. Give at once a hot bath and a
dose of from 20 to 30 drops of laudanum; afterwards one-fourth of the
following mixture should be taken every four hours. Sulphate of
magnesia, one ounce; powdered alum, two drams; tincture of opium, half a
dram; water, six ounces. Alum is considered to have special curative
powers where this disease has become chronic.
The following recipe is recommended to those exposed to the dangers of
lead poisoning. Elixir vitriol, one-half ounce; tincture of prickly ash
berries, one ounce; mix, and take a tea-spoonful in a gill of water
three or four times a day.
Paralysis or palsy sometimes arises from this disease, but is in general
confined to the wrists. Galvanism, with friction and shampooing should
be applied, with chalybeate waters.
COLIC IN CHILDREN.
Young children are very liable to attacks of colic, owing to acidity in
the stomach arising from injudicious over-feeding, or from giving them
solid food at too early an age. They often suffer severely from the
pains, throwing their little legs wildly about and screaming loudly.