=Heat Stroke and Electric Shock=
_How Persons are Overcome by Heat--Treatment of Sunstroke--Peculiar
Cases--Dangers of Electric Shocks--How Death is Caused--Rules and
Precautions._
=HEAT EXHAUSTION.=
_First Aid Rule 1.--Carry patient flat and lay in shade. Loosen
clothes at neck and waist._
_Rule 2.--Raise head and give him (a) teaspoonful of essence of ginger
in glass of hot water, or give him (b) half a cup of hot coffee,
clear._
_Rule 3.--Put him to bed._
=HEAT STROKE.=
_First Aid Rule 1.--Send for physician._
_Rule 2.--Remove quickly to shady place, loosening clothes on the
way._
_Rule 3.--Strip naked and put on wire mattress (or canvas cot), if
obtainable._
_Rule 4.--Sprinkle with ice water from watering pot, or dash it out of
basin with hand._
_Rule 5.--Dip sheet in ice water and tuck it snugly about patient._
_Rule 6.--Sprinkle outside of sheet with ice water; rub body, through
the sheet, with piece of ice. Put piece of ice to nape of neck._
_Rule 7.--When temperature falls to 98.5 deg. F. put to bed with ice cap
on head._
=SUNSTROKE.=--There are two very distinct types of sunstroke: (1) Heat
exhaustion or heat prostration. (2) Heat stroke.
Heat prostration or exhaustion occurs when persons weakened by
overwork, worry, or poor food are exposed to severe heat combined with
great physical exertion. It often attacks soldiers on the march, but
also those not exposed to the direct rays of the sun, as workers in
laundries, in boiler rooms, and in stoke-holes of steamers. The attack
begins more often in the afternoon or evening, in the case of those
exposed to out-of-door heat. Feelings of weakness, dizziness, and
restlessness, accompanied by headache, are among the first symptoms.
The face is very pale, the skin is cool and moist, although the
trouble often starts with sudden arrest of sweating. There is great
prostration, with feeble, rapid pulse, frequent and shallow breathing,
and lowered temperature, ranging often from 95 deg. to 96 deg. F. The patient
usually retains consciousness, but rarely there is complete
insensibility. The pernicious practice of permitting children at
seaside resorts to wade about in cold water while their heads are
bared to the burning sun is peculiarly adapted to favor heat
prostration.
Heat stroke happens more frequently to persons working hard under the
direct rays of the sun, especially laborers in large cities who are in
the habit of drinking some form of alcohol. It often occurs in
unventilated tenements on stifling nights. Dizziness, violent
headache, seeing spots before the eyes, nausea, and attempts at
vomiting, usher in the attack. Compare it with heat prostration, and
note the marked differences. The patient becomes suddenly and
completely insensible, and falls to the ground, the face is flushed,
the breathing is noisy and difficult, the pulse is strong, and the
thermometer placed in the bowel registers 107 deg., 108 deg., or 110 deg. F., or
rarely higher. The muscles are usually relaxed, but sometimes there
are twitchings, or even convulsions. Death often occurs within
twenty-four or thirty-six hours, preceded by failing pulse, deep
unconsciousness, and rapid breathing, often labored or gasping,
alternating with long intermissions. Sometimes delirium and
unconsciousness last for days. Diminution of fever and returning
consciousness herald recovery, but it is a very fatal disorder,
statistics showing a death rate of from thirty to fifty per cent. Even
when the patient lives, bad after effects are common. Peculiar
sensibility to moderate heat is a frequent complaint. Loss of memory,
weakened mental capacity, headache, irritability, fits, other mental
disturbances, and impairment of sight and hearing are among the more
usual sequels, occurring in those who do not subsequently avoid the
direct rays of the sun, as well as an elevated temperature, and who
indulge in alcoholic stimulants. A high degree of moisture in the air
favors sunstrokes, but it is a curious fact that sunstroke is much
more frequent in certain localities, and in special years than at
other places and times with identical climatic conditions. This has
led observers to suggest a germ origin of the disease, but this is
extremely doubtful.
=Treatment.=--Treatment for heat exhaustion is given in the
"first-aid" directions. Little need be added to the directions for
treatment of heat stroke. In place of the ice cap suggested in Rule 7,
ice in cloths, or in a sponge bag may be substituted. The friction of
the body, as directed in Rule 6, is absolutely necessary to stimulate
the nervous system and circulation, and to prevent the blood from
being driven into the internal organs by the cold applied externally.
The cold-water treatment is applied until the temperature falls down
to within a few degrees of normal--that is, 98.6 deg. F. Then the patient
should be put into bed, there to remain, with ice to the head, until
fully restored.
It often happens that the fever returns, in which event the whole
process of applying cold water must be repeated. The simplest way of
reducing the fever consists in laying the patient, entirely nude, on a
canvas cot or wire mattress, binding ice to the back of his neck, and
having an attendant stand on a chair near by and pour ice water upon
the patient from a garden watering pot.
While the patient is insensible no attempt should be made to give
anything by the mouth; but half a pint of milk and two raw eggs with a
pinch of salt may be injected into the rectum every eight hours, after
washing it out with cold water on each occasion. Two tablespoonfuls of
whisky may be added to the injection, if the pulse is weak. If the
urine is not passed spontaneously, it will be necessary to draw it
once in eight hours with a soft rubber catheter which has been boiled
ten minutes and lubricated with glycerin or clean vaseline.
=ELECTRIC SHOCK OR LIGHTNING STROKE.=
_First Aid Rule 1.--Protect yourself from being shocked by the victim.
Grasp victim only by coat tails or dry clothes. Put rubber boots on
your hands, or work through silk petticoat; or throw loop of rubber
suspenders or of dry rope around him to pull him off wire, or pry him
along with dry stick._
_Rule 2.--Do not lift, but drag victim away from wire toward the
ground. When free from wire, hold him head downward for two minutes._
_Rule 3.--Assist heart to regain its strength. Apply mustard plaster
(mustard and water) to chest over heart; wrap in blanket wrung out of
very hot water; give hypodermic of whisky, thirty minims._
_Rule 4.--Induce artificial respiration. Open his mouth and grasp
tongue, pull it forward just beyond lips, and hold it there. Let
another assistant grasp the arms just below the elbows and draw them
steadily upward by the sides of the patient's head to the ground, the
hands nearly meeting (which enlarges the capacity of the chest and
induces inspiration, Fig. 2). While this is being done, let a third
assistant take position astride the patient's hips with his elbows
resting on his own knees, his hands extended, ready for action. Next,
let the assistant standing at the head turn down the patient's arms to
the sides of the body, the assistant holding the tongue changing
hands, if necessary, to let the arms pass. Just before the patient's
hands reach the ground, the man astride the body will grasp the body
with his hands, the ball of the thumb resting on either side of the
pit of the stomach, the fingers falling into the grooves between the
short ribs. Now, using his knees as a pivot, he will at the moment the
patient's hands touch the ground throw (not too suddenly) all his
weight forward on his hands, and at the same time squeeze the waist
between them, as if he wished to force something in the chest upward
out of the mouth; he will deepen the pressure while he slowly counts
one, two, three, four (about five seconds), then suddenly lets go with
a final push, which will send him back to his first position. This
completes expiration. (A child or delicate person must be more gently
handled.)_
_At the instant of letting go, the man at the patient's head will
again draw the arms steadily upward to the sides of the patient's
head, as before (the assistant holding the tongue again changing
hands to let the arms pass, if necessary), holding them there while he
slowly counts one, two, three, four (about five seconds)._
_Repeat these movements deliberately and perseveringly twelve to
fifteen times in every minute--thus imitating the natural motions of
breathing. Continue the artificial respiration from one to four hours,
or until the patient breathes; and for a while, after the appearance
of returning life, carefully aid the first short gasps until deepened
into full breaths._
_Keep body warm with hot-water bottles, hot bricks to limbs and feet,
and blankets over exposed lower part of body._
_Rule 5.--Treat burn, if any. If skin is not broken, cover burn with
cloths wet with Carron oil (equal parts of limewater and linseed or
olive oil). If skin is broken, or raw surface is exposed, spread over
it paste of equal parts of boric acid and vaseline, and bandage over
all._
=Conditions, Etc.=--A shock produced by contact with an electric
current is not of rare occurrence. Lightning stroke is very uncommon;
statistics show that in the United States each year there is one death
from this cause to each million of inhabitants. There are several
conditions which must be borne in mind when considering the accidental
effect of an electric current. The pressure and strength of the
current (voltage and amperage) are often not nearly so important in
regard to the effects on the body, as the area, duration, and location
of the points of contact with the current, and the resistance offered
by clothing and dry skin to the penetration of the electricity.
When the heart lies in the course of the circuit, the danger is
greatest. A dog can be killed by a current of ten volts pressure when
contacts are made to the head and hind legs, because the current then
flows through the heart, while a current of eighty volts is required
to kill a dog, under the same conditions, if contacts are made to head
and fore leg. In a general way alternating currents of low frequency
are the most injurious to the body, and any current pressure higher
than two hundred volts is dangerous to life. On the other hand, a
current of ninety-five volts has proved fatal to a human being. In
this case the circumstances were particularly unfavorable to the
victim, as he was standing on an iron tank in boots wet with an
alkaline solution, and probably studded on the soles with nails, when
he came in accidental contact with an industrial current. Moreover, he
was an habitual drunkard. In an instance of the contrary sort, a man
received a current of 1,700 volts (periodicity about 130) for fifty
seconds, in one of the early attempts at electro-execution, without
being killed. The personal equation evidently enters into the matter.
A strong physique here, as in other cases, is most favorable in
resisting the effects of electric shock.
High-pressure alternating currents (1,300 to 2,000 volts) are employed
in electro-executions, and the contacts are carefully made, so that
the current will enter the brain and pass through the heart to the
leg. The two most vital parts are thus affected. In industrial
accidents such nice adjustments are fortunately almost impossible, and
shocks received from high-pressure currents, even of 25,000 volts,
have not proved fatal because both the voltage and amperage have been
greatly lessened through poor contacts and great resistance of
clothing and dry skin, and also because the heart is not usually
included in the circuit.
Death is induced in one of three ways: 1. Currents of enormous voltage
and amperage, as occur in lightning, actually destroy, burst and burn
the tissues through which the stroke passes. 2. Usually death follows
accidents from industrial currents, owing to contraction of the heart,
the effect being the same as observed on other muscles. The heart
instantly ceases beating, and either remains absolutely quiet, or
there is a fine quivering of some of its fibers, as seen on opening
the chest in experiments upon animals. 3. A fatal issue may result
from the passage of the current through the head, so affecting the
nerve centers that govern respiration that the breathing ceases.
=Symptoms.=--These are generally muscular contractions, faintness, and
unconsciousness (sometimes convulsions, if the current passes through
the head), with failure of pulse and of breathing. For instance, a
man who was removing a brush from a trolley car touched, with the
other hand, a live rail. His muscles immediately contracted throwing
him back, and disconnecting him from contact with the current (500
volts). He then fainted and became unconscious for a short time. The
pulse was rapid and feeble, and the breathing also at first, but it
later became slower than usual. On regaining sensibility the patient
vomited and got on his feet, although feeling very weak for two hours.
Unconsciousness commonly lasts only a few moments in nonfatal cases,
but may continue for hours, its continuance being rather a favorable
sign of ultimate recovery, if the heart and lungs are acting
sufficiently. Bad after effects are rare. It is not uncommon for the
patient to declare that the accident had improved his general
feelings. Occasionally there is temporary loss of muscular power, and
a case has been reported of nervous symptoms following electric shock
similar to those observed after any accidental violence. Burns of
varying degrees of intensity occur at the point of entrance of the
current, from slight blisters to complete destruction of all the
tissues.
=Treatment.=--The treatment is completely outlined in the "first-aid"
directions. Should contact be unbroken, an order to shut off the
electric current should at once be telephoned to the station.
Protection of the rescuer with thick rubber gloves is of course the
ideal safeguard.
In fatal cases the heart is instantaneously arrested, and nothing can
be done to start it into action. If the current passes through the
brain, by contact with the head or neck, then failure of breathing is
more apt to be the cause of death. Theoretically, it is in the latter
event only that treatment, i. e., artificial respiration, will be of
avail.
But as in any individual case the exact condition is always a matter
of doubt, _artificial respiration_ is the most valuable remedial
measure we possess; it should always be practiced for hours in
doubtful cases. Two tablespoonfuls of brandy or whisky in a cup of
warm water may be injected into the bowel, if a hypodermic syringe is
not available and the patient needs decided stimulation.