LIBRARY OF CONGRESS. -uC^A UNITED STATES OF AMERICA. ACCIDENTS AND EMERGENCIES DULLES. Showing the Course of the Principal Blood Vessels. See page 69. ACCIDENTS AND EMERGENCIES A MANUAL OF THE TREATMENT OF SURGICAL AND OTHER INJURIES IN THE ABSENCE OF A PHYSICIAN. CHARLES W. V T)ULLES, M.D., I* FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA AND OF TH1 ACADEMY OF SURGERY; SURGEON TO THE OUT-DOOR DEPARTMENT OF THE HOSPITAL OF THE^ UNIVERSITY OF PENNSYLVANIA AND OF THE PRESBYTERIAN HOSPITAL, IN PHILADELPHIA, ETC. THIRD EDITION, REVISED AND ENLARGED. m.ii\ Ntfo Illustration*. AP. 27 i. -r PHILADELPHIA : P. BLAKISTON, SON & CO., No. 1012 Walnut Street. 1883, t ^ Entered according to Act of Congress, in the year 1888, by P. BLAKISTON, SON & CO., In the Office of the Librarian of Congress, at Washington, D. C. PRESS OF WM F. FELL & CO., 1220-24 SANSOM ST., PHILADELPHIA. PREFACE TO THIRD EDITION. The exhaustion of two editions of this little book encourages the author to believe that it has proved useful in the past, and he presents this third edition in the hope that it may also prove useful. Whoever has seen how invaluable, in the presence of accident, is the man or woman with a cool head, a steady hand, and some knowledge of what is best to be done, will not fail to appreciate the desirability of possessing these qualifications. To have them in an emergency, one must acquire them before it arises, and it is with the hope of aiding any who wish to prepare themselves for such demands upon their own resources that the following sugges- tions have been put together. They are not meant to be elaborate, but simple and practicable. They cannot take the place of calling a physician or sur- geon, but may fill up with helpful action what might otherwise be a period of inaction and despair, before skilled assistance arrives. With this view I trust they may prove of some value to the public, to whom they are offered. v If the author may be permitted to suggest the way in which the instrument he has constructed ought to be used, it is as follows : Let it be read through, at least once, as carefully and as studiously as possible, so that the reader may make the acquaintance of its suggestions ; and then let it be kept in some handy place, where it can be referred to immediately when an emergency arises. In order to make it available for sudden necessity, pains have been taken to make the index as complete as possible, and the typography has been so arranged as that leading words may catch the eye on every page. Philadelphia, March, 1888. VI TABLE OF CONTENTS. PAGE Preface v Preliminary Remarks 9-1 1 Obstructions to Respiration 12-19 Drowning 12 Strangulation 16 Suffocation 16 Choking 17 Foreign Bodies in the Eye, Nose and Ear . . . 20-23 Fits or Seizures 24-34 Unconsciousness ■ 24 Fainting 29 Hysterics 30 Epileptic Fits 30 Convulsions in Children 32 Apoplexy 32 Intoxication 33 Catalepsy 34 Injuries to the Brain 35 Effects of Heat 36 Burns or Scalds 36 Sunburn 38 Sunstroke, or Heatstroke 38 Heat Exhaustion 39 Lightning Stroke 40 Effects of Cold 41, 42 Sprains 43, 44 Dislocations 45~47 Fractures 48-53 vii Vlll CONTENTS. PAGE Wounds 54-62 Contusions 54 Contused Wounds 55 Incised Wounds 55 Lacerated Wounds 56 Punctured Wounds 57 Splinters 58 Poisoned Wounds 59 Gunshot Wounds 61 Railroad and Machinery Accidents 63, 68 Hemorrhage — Bleeding 69-79 Special Hemorrhages 80,81 Transportation of Injured Persons 82-84 Poisons 85-95 Domestic Emergencies 96-103 Cholera Morbus 96 Vomiting or Nausea 97 Diarrhoea 98 Croup 99 Whooping Cough 100 Asthmatic Attacks • 100 Nervous Attacks 101 Toothache 101 Earache 102 Poisoning with Poison Vine 102 Signs of Death 104-106 Supplies for Emergencies . ■ .. ? 107 Surgical Case 107 Use of Contents of Surgical Case 108 Bandaging 109 How to Make Poultices 112 Medicine Chest 114 Doses and Uses of the Medicines 115 ACCIDENTS AND EMERGENCIES PRELIMINARY REMARKS. There is nothing so important in the presence of an accident or emergency as that some one with coolness and information enough should assume command and begin to set things right. Such an one will rarely fail to be recognized by those less efficient, and will usually find little difficulty in so directing them that they shall render some valuable assistance, or, at least, do no harm to the sufferer. Bystanders should first be urged not to crowd, but to leave room for breathing and action. Any scream- ing or wailing should be stopped, if possible. Then enough, and no more persons than are needed, should be called on to assist in removing the one in danger, or if he be crushed, in removing whatever presses upon him. Next his body should be placed in a comfortable position, lying down, with the head a very little raised ; after which an investi- b 9 10 ACCIDENTS AND EMERGENCIES. gation may be made to find out, as nearly as pos- sible, what is wrong, and a line of subsequent action decided upon. Some one should now be dispatched for a doctor, with a written message, if possible, and certainly with one that shall give the doctor a good idea of what he may expect to find when he arrives, so that he may come provided with necessary instruments or remedies. While awaiting him, whatever may be advisable is to be done by those at hand. Clothing may have to be loosened or removed, efforts at resuscitation made, a stretcher provided, or other means of trans- portation. Hot or cold applications may be needed, and should be got ready. Temporary splints, or means to control bleeding, may be required. These the bystanders ought at once to attend to. One thing, however, they ought not to do. That is, to give large quantities of whisky or brandy, as is the almost invariable custom with people who know nothing, but want to do something. If stimulants seem to be called for, the non-medical had better stick to hot water, or tea, or coffee, or milk; for alcoholic stimulants, except in small quantities, are, as a rule, not only unnecessary, but actually harmful. They often injure the patient, mislead the doctor, and interfere with the proper treatment of the case. Exceptions to this general statement may be dis- covered ; but they are exceptions — this is the rule. PRELIMINARY REMARKS. 11 Another important point to be observed, is not to do too much. It will be making a bad use of in- structions designed to bridge over the interval be- tween the occurrence of an accident and the coming of one whose whole time is given to the work of healing, if one who knows no more than can be gleaned from a little manual should act as if it had made a veritable doctor of him. Such presumption might lead to great mortification of the amateur and to great injury of the sufferer. The true principle is, when the urgency is pressing, to do what is known to be helpful ; and when one is not sure, to do nothing. 12 ACCIDENTS AND EMERGENCIES. Obstructions to Respiration. Drowning. It may seem almost absurd to say that the first thing to be done when one has been exposed to drowning is to remove the person from the water. Yet I well remember to have seen, some years ago, the revolting spectacle of a woman's body, fastened with a rope, floating in a river, and gazed at by hundreds of curious people. Upon inquiry, a policeman gravely informed me that no one dared take it out before the arrival of the Coroner. This is a mistake ; any one who thinks there is a chance of resuscitation should remove from the water a person presumed to have been drowned, and at once set about the work. If natural breathing has ceased, the first thing to be done is to free the body from any clothing which binds the neck, chest or waist, and to turn it over upon the face for a moment, thrusting a finger into the mouth and sweeping it round, to bring away anything that may have gotten in or accumu- lated there. Then the body should be laid out flat on the back, with something a few inches high under the shoulders (anything will do : a folded blanket, or a shawl, or coat, or stick of wood), so as to cause DROWNING. 13 the neck to be stretched out and the chin to be car- ried far from the chest. The tongue should now be drawn well forward out of the mouth and held by an assistant, or, if there be no one to do this, a pencil or small stick may be thrust across the mouth on top of the tongue and back of the last teeth, to keep the mouth open and the tongue out of the throat. A very good way to get the base of the tongue clear of the windpipe is to press the angles of the jaw for- ward with both thumbs applied just in front of the lobes of the ears. An effort to secure artificial respiration should now be be- gun. The simplest way to do this is for some one to place Fig. i. himself on his knees behind the head, seize both arms near the elbows and sweep them round horizon- tally, away from the body and over the head till they meet above it, when a good, strong pull must be made upon them, and kept up for a few seconds. This effects an inspiration — fills the lungs with air, 14 ACCIDENTS AND EMERGENCIES. by drawing the ribs up, and so enlarging the cavity of the chest. The second manoeuvre consists in returning the arms to their former position alongside the chest, and making strong pressure against the lower ribs, so as to drive the air out of the chest and effect an act of expiration. This need occupy but a second of time. If this plan is regularly carried out it will make about sixteen complete acts of respiration in a Fig. 2. minute. It should be kept up for a long time, and not abandoned until a competent person has ascer- tained that the heart has ceased to beat. The cessa- tion of the pulse at the wrists amounts to nothing as a sign of death ; and often life is present when only a most acute and practiced ear can detect the sound of the heart. In a moderately thin person, deep pressure with the finger ends just below the lower end of the breast bone may sometimes reveal pulsa- tion in the aorta, the main artery of the body, when it cannot be found anywhere else. It is important that the wet clothing shall be re- moved as soon as possible from a drowned person. DROWNING. 15 This can always be done without interrupting the artificial respiration. If exposure of the person must be avoided, something may be laid over the body (a coat, a shawl, a blanket, a sail), and the wet clothes loosened under it and drawn down over the feet. Then the body may be quickly slipped on to some- thing dry, and covered with some other fabric, if the first has become wet, while this, in its turn, is pulled away from underneath. Warmth is to be secured by any means which in- genuity may suggest — hot bottles, or plates, or bricks, or stones, or even boards that have lain in the summer sun. At the seashore there is plenty of hot sand, and often plenty of baking bathing costumes. The body and limbs may be gently, but constantly, rubbed toward the heart, to help the blood in its labored circulation. None of these things need interfere with the efforts to secure respiration, which must be uninterrupted. Some stimulant is to be given as soon as it can be swallowed. Teaspoonful doses of whisky* or brandy, in a tablespoonful of hot water, may be given every few minutes, till the danger point is passed. As natural respiration begins to be attempted, it should be aided as much as possible by timing the artificial to it. It may be stimulated by applying smelling salts, or hartshorn, to the nose, by slap- ping the skin, or by dashing hot water upon the chest. Where it is available, there is no stimulus to 18 ACCIDENTS AND EMERGENCIES. respiration better than that of a good Faradic bat- tery, used so as to cause a reflex sobbing, or deep breathing, by the pain it causes. Little by little natural breathing will take the place of the arti- ficial, but must not be left unwatched for some time. Nothing but danger from cold, or pressing neces- sity, should prompt the removal from one place to another of a person who is being resuscitated, before this has been thoroughly accomplished. If removal cannot be avoided, it must be effected with great care. After resuscitation the person should be put in a warm bed, being carried carefully, with the head low, and a watch should be kept to see that the breathing does not suddenly stop. Where natural breathing has not ceased, all the steps just described should be carried out, with the exception of artificial respiration. But this should be had recourse to upon the first evidence that natural respiration is failing. Strangulation, by hanging, or by anything which compresses the windpipe from the outside, is to be treated by re-establishing the respiration in the same way as for drowning. The obstruction is, of course, to be removed and natural respiration stimulated or artificial respiration employed. Suffocation with Noxious Gases or Vapors calls for instant removal to the fresh air and the establishment of natural respiration, or of artificial until the natural is re-established, as described in OBSTRUCTIONS TO RESPIRATION. 17 speaking of Drowning (Page 1 2). Gases like carbonic acid, illuminating gas, the fumes of charcoal, and the collections in mines, wells or privies, are very dan- gerous to life. The removal of a person from a well full of a poisonous gas is a very difficult and delicate matter. Some attempt may be made to dislodge or dissipate the gas. Buckets of water may be dashed down, or an open umbrella lowered by the handle and rapidly drawn up a number of times. But these efforts must not consume any more time than is required to prepare a man who can be lowered, securely fastened to the rope, so that he can attach another rope to the person overcome in the well. The rescuer must be brave, cool and strong, and those who lower him no less so. He may be some- what protected by wearing a sack over his head, or having a thick vail over his face. But everything will depend upon the rapidity with which he and his comrades can do their work. Choking caused by something sticking in the throat, gullet or windpipe demands its removal as soon as possible. It is not always easy to tell which of these latter passages is clogged, but usually there is active irritation, with coughing, when a foreign body lodges in the windpipe, while swallowing can be done quite readily. On the other hand, when the gullet is stopped it is usually impossible to swallow, and there is little or no tendency to cough, no matter how much the breathing may be interfered with. 18 ACCIDENTS AND EMERGENCIES. About the throat, it is not so hard to tell, for one can usually see or feel with the ringer the offending body. If a foreign body be within reach of two fingers, it may be pretty easily removed. If not, a pair of blunt-pointed scissors may be used like forceps. Or a hair pin may be straightened out and one end bent round so as to make a loop, and this used to try to dislodge the foreign body ; or the handle of one blade of a pair of scissors may be used in the same way. It has been stated that for foreign bodies in the throat, such as pieces of meat, etc., a simple mode of relief is to blow forcibly into the ear. This sometimes excites powerful reflex action, during which the foreign body is expelled. Such a plan is so easy of execution that it is certainly worth trying. Children not infrequently get buttons, or coins, or marbles in their throats, and come near choking to death. These may often be pulled out, or expelled by vomiting, if this can be provoked. Holding the body up by the legs, with the head hanging down, has sometimes aided other efforts to get rid of such things, The responsibility of attempts to poke them down may well be left for the surgeon. If pins, or needles, or fish bones, get stuck in the mouth or throat, it is sometimes an extremely deli- cate matter to remove them. Sometimes, on the other hand, they may be grasped with the fingers or a pair of blunt scissors — used like forceps — and pulled out. If this cannot be done, the patient should be OBSTRUCTIONS TO RESPIRATION. 19 made to lie down, and kept as quiet as possible in body and mind, till some one comes who can give relief.* If foreign bodies get into the windpipe they will soon be coughed out, or require surgical skill for their removal. A moderate blow on the back with the open hand, or a quick strong squeeze of the chest, sometimes aids the coughing act ; and invert- ing the body may assist in dislodging the foreign body if it be not too tightly wedged in. In any case where the breathing is not seriously interfered with, it will be most prudent for non- medical persons to keep " hands off." For there may no longer be anything in the throat, though it appears there is ; and it can do no good to make groping efforts to bring away foreign substances friat have already gone down into the stomach, only leaving behind an irritation which deceives the patient and his friends. When strange things, like coins, or marbles, or slate pencils, or nails, are swallowed by children (or adults), it is a mistake to give a purgative. The proper plan is to let the bowels alone and to give plenty of good solid food, especially vegetables, so that the foreign body may be surrounded with the waste and carried out of the body without injuring the walls of the intestines. * The practice, by adults, of putting pins in the mouth, is neither clean nor safe, and is to be discountenanced. 20 ACCIDENTS AND EMERGENCIES. Foreign Bodies in the Eye, Nose and Ear. Foreign Bodies in the Eye. Small substances like cinders, dust or small chips of stone or metal, can usually be removed from the eye by very simple means. Sometimes there is at once a free flow of tears which washes them out. At others, the com- mon way of catching the upper lid by the lashes and pulling it away from the eyeball and down over the lower lid, then letting it go so that as it recedes its under surface is swept by the lashes of the lower lidf* will clear it out. If this does not prove successful, a loop made of a horse hair, or a long human hair, can be passed under the lid and swept, from the outer side, toward the nose and drawn down. This may serve the purpose. If it does not, the upper lid must be everted, or turned inside out. This is easy to do. One way is to seize the lashes between the thumb and first finger, and to draw the edge of the lid away from the eye- ball. At the same moment the end of the second finger is pressed against the skin of the lid above its FOREIGN BODIES IN EYE, NOSE AND EAR. 21 edge. The patient is now told to look down, and, as he does so, the lashes and edge of the lid are pulled upward toward the eyebrow, while the upper part is tucked under it with the end of the second finger. Another -plan is to draw the lid down, take a slender pencil, or knitting or crochet needle, and place it against the eyelid, parallel to and one-third of an inch above the edge, and then to pull the edge up and turn it over this by means of the lashes. The lower part of the eye is easy to examine, be- cause the lower lid is so easy to turn down. In this way a large part of the eyeball and eyelid can be examined and any foreign substance re- moved. A magnifying glass is sometimes needed to see fragments that have given a great deal of trouble. One must be on his guard against the sensation which is sometimes left after a foreign body has been removed from the eye. It often feels to the sufferer as though this were still in his eye when it is not. But a most careful search should be made before this is taken to be a self-deception ; and even then it would be better to consult a more skilled person. After removing a foreign body from the eye, the irritation may be sufficient to demand cool, wet ap- plications, or even anodynes. Nothing is better than a thin mucilage of pure, clean gum-arabic poured freely in the eye. Or, a little laudanum may 22 ACCIDENTS AND EMERGENCIES. be poured into a heated cup, and when evaporated to a kind of jelly it can be thinned out with clear water and this poured into the eye. A bandage, loosely applied so as to shut out light and keep the eyeball rather quiet, often does much good. When lime gets in the eye it burns very severely. At once the eye should be deluged with water, and a little vinegar or lemon juice and water (a teaspoon- ful of vinegar or lemon juice to a teacupful of water) poured over the eyeball. Foreign Bodies in the Nose. Children sometimes place, or have placed, in their noses small bodies, such as marbles, buttons, peas, beans or small grains. To get rid of them, the nose should be blown hard; or, sneezing may be excited by tickling the nose or giving snuff ; or, the child may be told to take a full breath and then be given a smart blow on the back. Some one of these plans may dislodge the foreign body. If it does not, rea- sonable efforts may be made to fish it out with a bent hair-pin, a bodkin, the handle of a mustard or salt spoon, or something of that sort. But these efforts must not be rough or prolonged ; for they may do much damage; and if a surgeon must be called, the sooner it is done the better. The longer it is delayed, the harder will be his work and the worse for the child. In case peas or beans are lodged in the nose, the danger is increased by the FOREIGN BODIES IN EYE, NOSE^ AND EAR. 23 fact that if they absorb any moisture, they swell up and are very difficult to get away. Foreign Bodies in the Ear. The removal of foreign bodies from the ear is more delicate than when they are in the nose, because there is no way of getting at them from behind, and there is no natural force to be called to one's assistance. Consequently it usually requires special instruments. Yet, if no medical man be attainable at all, and if it be remem- bered that the outer passage of the ear is about an inch deep and very delicate, something may be done. If the body be a metal or mineral one, the ear may be syringed out thoroughly. The person's head must be held with the face down, as in this position gravity lends some assistance. Very gentle efforts may even be made to remove any foreign body with a crochet needle, or a hair-pin, or an ear spoon, if it can be had. But with all these it must be remem- bered that great damage may be done by the least roughness. If live insects get into the ear, oil or glycerine or salt and water should be poured in. Or, a plug of cotton soaked in a strong solution of salt and vine- gar may be placed in the ear and the head turned over on that side. An ingenious method, which has sometimes been successful, is to turn the ear at once to a bright light, so as to tempt the insect to back out, on account of the attraction which light has for all these creatures. 24 ACCIDENTS AND EMERGENCIES. Fits or Seizures. Unconsciousness, or Insensibility, occurs in many different conditions, and it is of great import- ance that something should be known about them by those who meet many strangers, or have the care of large numbers of employees. To this class belong railway officials and railway servants, manufacturers, superintendents of mines and public works, survey- ors, constructors, keepers of hotels, and schoolmas- ters, and policemen. The former might often do priceless service to those who come under their care, and the last might escape much blame and avoid some unfortunate mistakes, if they could always distinguish disease from disorder and drunkenness. This, it must be acknowledged, is often hard to do. But so much the more reason is there for at- tempting to learn enough to prevent such shameful mistakes as are sometimes made. So, before speak- ing of the treatment of conditions in which uncon- sciousness may be present, a little space may be devoted to considering, in a general way, how one may decide what unconsciousness is due to. For our present purpose the causes of uncon- sciousness may be classified as : disorders of the FITS OR SEIZURES. 25 circulation, disorders of the brain, poisoning, and intoxication. Unconsciousness due to Disorder of the Cir- culation, or temporary failure of the heart, is^ famil- iarly illustrated in fainting. This may be brought about by a simple nervous influence, or by a sudden shock, or by loss of blood. In any case, the condi- tion is easily recognized by itself or from its cause. It is marked by paleness of the face, and usually by coldness of the extremities. Unconsciousness due to Disorder of the Brain may depend upon disease or injury. Disease of the brain is recognizable, from its gradual ap- proach, which can be learned from the sufferers friends, and is not much more likely to prove per- plexing than is fainting. On the other hand, inju- ries of the brain are usually accompanied by external signs, such as dirt, swelling, bruises or cuts, which show that violence has been inflicted ; or, they occur under circumstances which make a suspicion of vio- lence reasonable. In apoplexies some of the external evidences might prove misleading, but besides these there is often found an unequal dilatation of the pupils, and paralysis on one side of the face and body. In the unconsciousness of epileptic convulsions there is usually little trouble in deciding what is present, from the frothing, and biting of the tongue or lips, and the peculiar cry before unconsciousness sets in, with which every one is familiar, c 26 ACCIDENTS AND EMERGENCIES. Unconsciousness due to Poison may be caused by a poison generated within the body: an example of which sometimes occurs in serious kidney disease. In such cases there are usually convulsions as well as unconsciousness, and often a dropsical appearance about the eyes and legs, very profound stupor, and a smell like that of urine about the person affected. The cause of poisoning by gases is generally easy to detect. The only insensibility due to drugs which is actually likely to be confused with intoxication is that caused by opium or chloral. But in this the pupils are strongly and rigidly contracted — the very opposite of what is seen in drunkenness. Unconsciousness due to Intoxication is marked, it is true, by many signs of other insensibili- ties, but it has these peculiarities : the face is usually flushed, the body relaxed everywhere, the person ca- pable of being roused by loud cries, the pupils dilated evenly, and a distinct odor of liquor to be dis- covered. When a doubtful cases arises the first thing to be done is to see if there is an odor of liquor to be dis- covered. If there is not, one may be sure he is not dealing with a case of intoxication. But if, on the other hand, the odor is present, one must not con- clude at once that the case is one of simple drunken- ness. For it often happens that liquor is given after an accident, and an accident may have happened to FITS OR SEIZURES. 27 a man who had been drinking. To avoid mis- take : — i. The head must be examined. If there is a cut or a bruise, the only safe thing to conclude is that there is a brain injury, received before or after the liquor was taken. 2. The pupils of the eyes must be examined. If they are permanently contracted and do not dilate when the eyes are shaded, it is probably a case of brain disease or opium poisoning. If one pupil is con- tracted and the other dilated, it is a case of injury or disease of the brain. 3. The face must be examined. If it is drawn and wrinkled on one side, and smooth on the other, the case is one of apoplexy, or stoppage of a blood vessel in the brain, or pressure upon some part of the brain. 4. The mouth must be examined. If it be frothy and if the tongue or the lip be bitten, it is probably a case of epilepsy or some other convulsive disorder — not simply intoxication . Of course, it will be borne in mind that the tongue may be bitten accidentally by being caught between the teeth in a fall. 5. The arms and legs must be examined. If one is stiff and one limber, or if one moves when pinched and the other does not, it is a one-sided paralysis, or hysterics. If it be the latter, the person affected will usually resist any attempt that may be made to open the eyelids; and when the eyelids are forcibly 28 ACCIDENTS AND EMERGENCIES. opened the eyeballs will usually be found persist- ently rolled up, which may be regarded as an almost infallible evidence of hysterics. At the same time close watching will generally lead to the discovery of some sign that the affected person is listening to what is being said about him or her. 6. The temperature of the skin must be investigated. If the skin be burning hot and dry, sunstroke or heat- stroke may be suspected, if the time of year or the occupation of the patient warrant such conclusion. After all these tests have been applied, there will still be a few cases where it will be hard to say — in the presence of an odor of alcoholic liquor — whether there is, or is not, some more serious trouble than mere drunkenness present. In these few cases the only safe course is to take it for granted that there is some other trouble present — even if there be intoxica- tion, too — though it be at the risk of being sometimes deceived and imposed upon. When there is any such doubt the person should be transported and treated with great care, an attempt being made to discover what is the disease or injury which, alone or combined with intoxication, has produced the con- dition in which he has been found. Such a person should never be made to walk to a station house or be confined alone, or be permitted to escape the vigilance of those who take charge of him, till they can rest the responsibility of his fate on others better in- structed or in authority over them. FITS OR SEIZURES. 29 The treatment suitable for all cases in which there is doubt as to the cause of unconsciousness is to secure quiet and rest, the body being laid upon the back, with the head a little raised. If there be great paleness and a cold surface, with slow, sighing breathing — the signs of prostration : smelling salts or hartshorn may be held un.der the nose, hot tea or coffee given, and heat applied to the body. If there be great heat of the surface, cold may be applied to the body and head, and cold drinks given. With these general remarks on the way to decide between simple intoxication and other causes of loss of consciousness, let us now consider separately the way in which doubtful cases should be managed, and several common forms of fits or seizures. Fainting is too familiar to need much detail of symptoms. It is due to a temporary weakening or pause in the heart's action, causing a diminution or suspension of the circulation of blood in the brain, and a consequent loss of consciousness. This is accompanied with a loss of muscular power, so that the individual, if standing, falls. The pallor of fainting is very well known, and is simply a signal of the like bloodlessness which obtains in the brain itself. Usually no treatment is demanded in faint- ing, for a wise provision of Nature puts the person who faints in the best position for recovery, that is, lying down. But if in any way this is prevented from happening of itself, it should be brought about 30 ACCIDENTS AND EMERGENCIES. by a bystander. A fainting person must be laid out flat at once. The head must be put as low as, or lower than, the body, so that the heart may not have to work against the force of gravitation in send- ing blood to the brain. Sprinkling water upon the face, and holding smelling salts to the nose tend to excite the nerves of sensation, and rouse the brain and heart to renewed activity. So they are useful. Nothing else is usually necessary ; though if a person is very slow in coming to, it may be well to apply heat to the pit of the stomach. But of all, the first, the indispensable thing, is to lay the fainting person down flat. Nothing should be allowed to interfere with this. Hysterics — not hysteria, for that is usually a tedious and inscrutable nervous disease — but fits of hysterics, marked by prolonged and uncontrollable laughing or crying, are best treated by the exercise of calmness and patience on the part of the bystanders, sometimes by taking no notice of the attack,, or by leaving the unfortunate sufferer in a room by herself or himself — for men are at times subject to this curious disorder. Heroic measures, like dashing water into the face, are not to be generally recom- mended. Good is sometimes done by giving vale- rian or Hoffman's anodyne, if it can be obtained. In Epileptic Fits the sufferer usually has a warn- ing sensation, and often starts up to leave the place he is in. There is in the attack a pallor or lividity FITS OR SEIZURES. 31 of the face, a peculiar cry, loss of consciousness, a moment of rigidity, and then the face becomes con- gested and violent convulsions come on. In these there is usually some foaming at the mouth, the eyes roll or are turned up, and often the tongue or lips are bitten. Epileptic fits are to be treated very much like fainting fits, because in them also the brain is tempo- rarily bloodless. At the same time any movements calculated to injure the person must be controlled. There is no use in struggling against such as will do no injury ; they had better be simply regulated, and no attempt made to entirely prevent them ; but a folded towel or a piece of soft wood may be — if it can be — thrust between the teeth, to prevent the usual biting of the tongue. When the height of the con- vulsion is passed, rest, quiet, and perhaps a moderate stimulation may be secured. Here again the flat position of the body must be obtained. I remember, one summer, at the seashore, to have seen some ill-advised, though kind-hearted, persons walking a boy up and down the beach during an epileptic attack, because, from his pallid face, they thought he was suffering from the cold ; and they were much astonished at the rapidity with which he regained consciousness when laid out flat on the sand. It would be a good plan if every one who is sub- ject to epileptic attacks had his, or her, name and address placed just inside the coat, or in some place 32 ACCIDENTS AND EMERGENCIES. where it could be seen at once when the clothing is loosened to give relief, as is almost invariably done when such attacks occur. Epileptics should not, except when it is absolutely unavoidable, go about alone, or go into crowded places. They have no right, on their own account and for the sake of others, to incur the risks involved in such conduct, except under the stress of necessity. Convulsions of Children and Infants are generally (in the absence of brain or kidney disease) due to some irritation of the digestive apparatus or to teething. They are usually preceded by some other evidence of irritation, such as restlessness and fretfulness. When they come on, there is a loss of consciousness, and spasms. These may affect the whole body at once, or only a half, or only one limb at a time. The eyeballs sometimes roll about, or they squint, or they are turned far up so that only the lower part of them can be seen. When convulsions occur, the child should have cold applied to the head and heat to the body. It often seems to do good to place it into a tub of hot water to which some mustard has been added. A large injection of hot soap suds should also be given, to clear the bowels out, and, if possible, an emetic, in the hope of removing some cause of trouble from the stomach. Apoplexy consists in the rupture of a blood vessel in the brain, and is marked by a slow pulse, more or FITS OR SEIZURES. 33 less sudden loss of consciousness, stupor, heavy snor- ing breathing, and usually a deeply flushed face. The pupils are generally dilated. Paralysis may be ob- served at once, or it may appear after some time. Usually it is limited to one side, and may be detected by observing that one side of the face is drawn up, while the other looks flabby, and the corner of the mouth on that side hangs down a little. The drawn side is not the paralyzed one, as is sometimes sup- posed. For this condition, rest and cold to the head con- stitute the best treatment until medical advice, which is indispensable, can be obtained. If this cannot be had for some time, the bowels should be emptied, if possible, with an injection of hot water and soap, and a purgative given by the mouth as soon as it can be swallowed. Intoxication sometimes closely resembles apo- plexy, and should be treated in the same way until its identity can be safely established. For this the odor of the breath is a useful guide, though it may be due to a stimulant, given by a bystander after an accident, or taken just before one. In addition, it may be remembered that, in a case of deep drunk- enness there is no paralysis, though there is help- lessness equally on both sides ; that the person can be aroused from the stupor, and that generally if the eyeball be touched he will attempt to close the eye- lids. In such a case an emetic should be given, and, 34 ACCIDENTS AND EMERGENCIES. if any hartshorn or aromatic spirits of ammonia is at hand, a teaspoonful of this in a teacupful of water. A large draught of vinegar will often go a great way toward sobering an intoxicated person. If there is much evidence of prostration, with cold, clammy skin, heat will have to be applied to the body, to prevent collapse. Emetics are sometimes of value in cases of profound intoxication ; but it must be borne in mind that, if a mistake be made — as has been — and the trouble be an apoplexy, no more dangerous thing could be done than to give an emetic. Catalepsy is a very rare state, somewhat resem- bling death, marked by more or less pallor of the skin, rigidity of the muscles, and apparent uncon- sciousness. In itself it is by no means dangerous, and it affords time enough to summon a doctor ; which is the only sensible thing to do under these circumstances. INJURIES TO THE BRAIN. 35 Injuries to the Brain. Concussion of the Brain, or stunning, may be caused by blows or falls on the head, or even by falls upon the feet. In such cases there is sickness, some- times fainting, with paleness and depression. There is also usually confusion of ideas, and the sufferer cannot talk continuously and coherently. There may even be unconsciousness. The proper treatment for this condition is to lay the sufferer out flat on the back, loosen any clothing that binds his neck or waist, and secure quiet and plenty of fresh air. If the skin becomes cold and clammy, heat should be applied to the body and limbs. No whisky or brandy should be given, except by a doctor's order. Compression of the Brain. This is caused by the pressure of broken bone upon the brain after a fracture of the skull, or by the pressure of blood poured out in a hemorrhage inside of the skull. The symptoms are loss of consciousness, sometimes par- alysis, sometimes twitching of the muscles, or even convulsions, and usually heavy snoring breathing, with wide dilatation of one or both pupils. The treatment is the same as for apoplexy. (See p. 32.) 36 ACCIDENTS AND EMERGENCIES. Effects of Heat. Burns or Scalds are usually dangerous in pro- portion to their extent and depth. Those which involve as much as half the surface of the skin are almost necessarily fatal. The treatment of burns may be divided under two heads. The first is for the moment of the accident. When clothes are on fire the wearer must not run about, but lie down and be covered with a rug, or blanket, or carpet, or shawl, or coat — anything which will exclude the air and smother the flame. If, in fright, the sufferer lose presence of mind, some bystander must take the responsibility of throwing her (for these accidents usually happen to women, on account of the character of their clothing) down and enveloping her with some thick cover. After an extensive burn or scald, so much of the clothing as has to be removed must be clipped away, so as not to burst blisters that have formed. These may be punctured at one edge and their contents allowed to run out, and the elevated cuticle, or outer skin, to fall down upon the deeper layer. Then a dressing of pure sweet oil, or castor oil, is to be applied on strips of soft old linen, and disturbed as EFFECTS OF HEAT. 37 little as possible afterward. It is customary in hos- pitals to clip away the clothing and envelop the patient in lint soaked in " Carron oil " (which is a mixture of equal parts of linseed oil and lime water), and to administer stimulants and anodynes. In case of a person severely and extensively burned, the entire body may be immersed in a bath, which shall be kept, as long as necessary, at a temperature of ioo°. When the shock of a burn is great some stimulant should be given, and laudanum, in twenty-drop doses to an adult, and half as much to a child, to allay the suffering. Of course, medical advice will be taken in such grave circumstances. Slight Burns or Scalds are best treated by applying a cloth soaked in a strong solution of baking soda — the bicarbonate, in the proportion of a heap- ing tablespoonful in a teacupful of water, or it may be powdered on without using any water. This usually allays the pain more effectually than anything else that is known. Carron oil is a good application for such burns. So is the white of egg, and in an emergency damp earth might be used, or white lead paint. Anything may be used which will prevent friction and exclude the air ; but nothing should be used which will stick in cakes and prevent after- examination, or make this very painful. For this reason flour and cotton batting, though often recom- mended, had better not be used. For small burns, simple cool water is better in every way than these. 38 ACCIDENTS AND EMERGENCIES. Indeed, for any but the most extensive burns it is one of the best remedies. An arm or a leg can be immersed in it and left there a long while with great advantage. Burns with acids must be deluged with water and then treated like other burns. Burns with caustic alkalies, such as soap-lye, should be treated with an application of vinegar, followed by applications of oil. Burns with hot pitch. After such burns the pitch often sticks. In such a case it ought not to be removed, but let alone. Sunburn, and the burns caused by external appli- cations, like mustard, may be treated very success- fully with the baking soda. This may also be mixed with vaseline, or cosmoline, or lard from which the salt has been boiled out, in equal parts, and used as an ointment. Sunstroke, or more properly Heatstroke, is not even usually due to the direct rays of the sun, but rather to a prolonged elevation of the bodily tem- perature, oftenest while working, and especially in confined places. When it takes place in the open air it is apt to be on oppressive, heavy, or murky days. It is generally preceded for some time by pain in the head and a sense of oppression. The attack, however, culminates in a loss of conscious- ness, with heavy, labored breathing, and an intense, burning, dry heat of the skin, while the bladder and EFFECTS OF HEAT. 39 bowels are often involuntarily evacuated. The absence of perspiration in the presence of so great heat is one of the most characteristic symptoms of heatstroke. When it occurs the thing to be done is to lower the temperature. As much of the clothing as pos- sible must be removed, and the patient should be transported to a cool and airy place, if possible. Cold must then be applied to the head and body, and ice may be rubbed over the chest and placed in the armpits. Pouring, or dashing, cold water over the body is not to be advised, as it conveys a needless shock to the system ; but there is nothing better than to place the body in a cold bath, or to wrap it in sheets kept wet and cold by renewed applications of cold water or ice. After a while consciousness will return. Then the cold may be discontinued, and renewed only if the surface becomes again very hot — that is, hot in contrast to that of a well person, not in con- trast to the ice or water that has been used — or in case consciousness should be lost again. It must always be remembered that sunstroke, or heatstroke, is a very dangerous thing, and may be followed by grave and permanent impairment of the intellect. Heat Exhaustion. This is a condition of great depression of the system due to the action of heat, and, occurring in hot weather, it might be confounded 40 ACCIDENTS AND EMERGENCIES. with sunstroke or heatstroke. But in heat exhaustion, instead of a hot, dry skin, there is a cold, moist one. This calls for rest, fresh air, a cool apartment ; but no application of cold to the surface. Small doses of brandy, thoroughly diluted, may be given, and the system gradually brought back from its depres- sion. Lightning Stroke. This is marked by evidences of shock, with reduction of the force of the circula- tion, weak pulse, and slow, sighing breathing. It must be treated with rest and stimulants, and warmth applied to the body. EFFECTS OF COLD. 41 Effects of Cold. Freezing sometimes takes place in so insidious a way that the sufferer is not aware of it until great damage has been done. Toes are perhaps oftenest frozen or frost-bitten. This results partly from the practice of wearing tight and insufficient coverings on the feet. When it occurs, it is best treated by gradually bringing the temperature up to that which is normal — about 98 Fahrenheit — and maintaining it there. Warm baths, gentle friction, and afterward covering with a thick, hot poultice, is the best thing that can be done until medical help can be obtained. This is important in such cases, because not infre- quently gangrene follows the freezing of the feet, making it necessary to amputate parts of them. Frozen fingers, ears, or noses are of less frequent occurrence, but must be treated on the same prin- ciples. If the whole body has been exposed to extreme cold, there will follow a depression which requires the most cautious treatment. To restore its warmth is the first demand, and for this a warm bath, made gradually warmer until as hot as can be well borne, surrounding with heated blankets, or exposure before D 42 ACCIDENTS AND EMERGENCIES. an open fire may be used.* At the same time stimu- lants may be given internally, such as hot tea or coffee, with the addition of small quantities of spirits. * This recommendation is contrary to popular belief and contrary to what is taught in most text-books, as well as in books on the treatment of emergencies. But it has been proved to be correct, by experiments made in Russia, where it was found that the best way to resuscitate dogs which had been frozen, was to put them at once into a hot bath. Of twenty ani- mals treated by the " gradual " method in a cold room, fourteen died; of twenty introduced at once into a warm room, eight died ; of twenty placed immediately in a hot bath, all recovered. SPRAINS. 43 Sprains. Sprains of the finger or wrist usually require cold and moist applications. In the latter, the hand and forearm should be laid on a straight splint, cov- ered with cotton so as to make the surface soft, and be lightly secured to it with a soft bandage or broad strips of sticking plaster. One of these should go round the hand and one or two round the forearm above the wrist — not over it. Sprains must be treated by rest, and heat or cold, whichever gives the most comfort. Sprains of the ankle should never be treated lightly. In them there is not infrequently a little fracture of the inner surface of one of the leg bones that form the ankle joint. This complication gives rise to so much trouble, and requires such skillful and patient treatment, that it has come to be believed that it is better to have a broken leg than a sprained ankle. The general principle, however, in the case of a sprained ankle is, first to put the joint at com- plete rest, then to allay inflammation, if it arises, and afterward to promote the absorption of inflammatory products. For the first, a splint and bandage are 44 ACCIDENTS AND EMERGENCIES* usually necessary ; for the second, friction, kneading of the joint, at times careful motion of it, and the use of moist heat. But in few cases is it truer that " he who doctors himself has a fool for a patient/ ' DISLOCATIONS. 45 Dislocations. Dislocations consist of the displacement of the articular or joint end of a bone. They cannot occur (except when the same joint has been out of place before) without the tearing of ligaments whose func- tion it is to keep the joint close. They can be detected by the occurrence of pain and stiffness of the joint. There is also deformity, which can gen- erally be made apparent by comparing the injured joint with the corresponding sound one of the other side. Dislocation of the fingers can usually be re- duced — or put in place — by strong pulling, aided by a little pressure upon the parts of the bones nearest the joint. They must be retained in place with a splint and bandage, or sticking plaster. Dislocations of the thumb are, even for surgeons, sometimes almost impossible to put in place. Dislocation of the lower jaw may be treated by almost any one. This is fortunate, since it is a very awkward dislocation, and very trying to the patient. It may occur at any time and under the most unex- pected circumstances. To reduce a dislocation of this sort, the sides of 46 ACCIDENTS AND EMERGENCIES, the jaw must be seized between the thumb and fingers of each hand, with the thumbs resting on the teeth and the fingers below the jaw, and firm pressure be made, first downward and then backward. It must be remembered to cover the thumbs with several thicknesses of cloth, and as soon as the jaw starts into place, to slip them off to the outer side of the teeth, inside the cheeks, or the releaser will be rewarded by having his thumbs mashed between the upper and nether millstones. He must be quick as lightning, too, for the muscles do not wait, when they have been so unnaturally on the stretch, but bring the lower teeth against the upper like a hammer. There is still another form of dislocation of the jaw, in which this is just a little open and cannot be opened any wider or closed. The thing to do in such a case is to slip a strong spoon handle or table knife in between the teeth and pry the jaw wider open. This will make the bone slip back into its place. Dislocations of the shoulder, that is of the upper arm bone from its socket, may be reduced by laying the patient down, sitting alongside of and facing him, and placing the nearest heel (with the boot or shoe removed) in the arm pit of the injured side, and then drawing down the dislocated arm and dragging it over toward the sound side. This will usually pry the head of the bone outward and DISLOCATIONS. 47 upward into its place. If it does not succeed readily, the amateur surgeon had better let it alone. If it does succeed, the bone will go in with a snap. The arm should then be bound to the side, with the fore- arm carried across the chest and the hand placed on the opposite shoulder. Dislocations of other joints ought not to be tampered with at all. The best that can be done is to put the parts in the position easiest to the sufferer, surround the joint with cold, wet cloths, to which laudanum has been added, and send for a surgeon. The risk of doing injury by injudicious efforts to set a joint is greater than that of waiting until a surgeon can be summoned. 48 ACCIDENTS AND EMERGENCIES, Fractures — Broken Bones. Broken bones may be recognized by the occur- rence of pain, by deformity, by bending where they ought not to bend, and by a sound and feeling of grating at the point of fracture. There are two im- portant divisions of fractures. Simple fractures, in which the break does not communicate by a wound with the air, and compound fractures, in which the bone cuts through the skin, or there is an opening from the exterior to the seat of fracture. The latter are far more serious and dangerous than the former. Broken bones require treatment as various as the fractures themselves are. Most of them require special appliances, known only to surgeons, and no attempt should be made by any one who has not surgical training to do more than treat a fracture temporarily. However, until the presence of a sur- geon can be secured, the following suggestions may be adopted, as far as the circumstances will permit. Fracture of the upper arm. In this the elbow should be drawn down and placed against the side of the chest, with a layer of cotton or linen cloth between. Then the whole upper arm should be FRACTURES — BROKEN BONES. 49 bound securely to the body and the forearm carried in a sling so arranged that the hand shall be raised a little higher than the elbow. Fracture of the forearm. In this the arm should be bent at the elbow, and placed in as nearly a natural position as possible, with the thumb point- ing up. Then a broad, well -padded splint should be placed along the back of the forearm and hand, going all the way to the tips of the fingers, and another along the front, padded so as to fit to the proper shape of the parts. The splints should be bound on pretty firmly, and the hand carried in a sling and raised a little higher than the elbow. Fracture of the finger. A broken finger should be straightened out, and bound to a very light splint reaching from the wrist to the tip of the finger. Fracture of the thigh bone. In this fracture the thigh must be bent up toward the abdomen and the lower leg back toward the thigh, so as to relax all the muscles. Then one splint can be applied to the outer side of the thigh and one to the inner, and bound to it. The sufferer should then have both legs tied together, and lie on his side on a firm bed, in a z shaped position, with the broken limb upper- most, the heel drawn up near to the buttocks, and the knee opposite the other knee. Fracture of the knee-pan. In this the whole leg must be bound to a straight splint placed at the 50 ACCIDENTS AND EMERGENCIES. back of the limb and going from the hip to the heel. A folded towel, or other small pad, should be placed in the hollow at the bend of the knee, so that the leg may not be held absolutely straight ; for this posi- tion soon becomes very painful. Fracture of the leg below the knee. In this the leg should be drawn down and placed in a natural position, using the sound leg for comparison. Then a pillow should be placed under it. Under this, Fig. 3. broad bandages should be passed and tied together over the limb, so as to draw the sides of the pillow pretty firmly up against it. (See Fig. 3.) A light piece of board, or several such pieces, may be bound on afterward to secure greater steadiness, or the other leg may be used as a splint, by binding the injured one to it. In fracture near or at a joint it is best to bend the joint a little, and lay the limb flat on a pillow, FRACTURES — BROKEN BONES. 51 keeping it cool and moist. These breaks are espe- cially grave, and demand the best skill that can be obtained. Fractures of bones that lie deep in the body, like the hip bone or the shoulder blade, are fortu- nately very rare. They are hard to detect, and can be treated only by placing the sufferer in a comfort- able position and securing rest and coolness till a surgeon comes. Fractures of the ribs must be treated in the same way. It is a good plan, however, to put on the side of the chest where the break is, long strips of sticking plaster, about two inches wide, placed par- allel to the ribs, beginning at the lowest part of the chest and going up, each strip be- ing made to overlap the one below about half its width. The strips should extend from the spinal column to the mid- dle of the breast bone. This makes the chest wall more rigid and prevents the rubbing together of the broken ends of the bone. (See Fig. 40 In fracture of the collar-bone the patient should be laid on his back, on a hard, flat, hair mattress, or on a settee, with a folded blanket under him (never on feathers), without any pillow, Fig. 4. 52 ACCIDENTS AND EMERGENCIES. and kept so until the surgeon comes. This is one of the best ways to treat a broken collar-bone until it is quite healed. In fracture of the jaw, close the mouth and put a bandage round, so as to keep the two rows of teeth against each other. (See Fig. SO In fracture of the skull there is nothing the non- medical can do better than to place the patient on his back, and to apply cold, wet cloths to the head. Fractures of the spinal column (broken back) are very hard to detect, but if one be suspected the patient must be moved as little as possible. He had best be laid out upon his back, and, if possible, not be disturbed till the surgeon directs it. Turning such a patient over upon his face is dangerous, and must not be permitted. Compound fractures, as has been remarked, are those in which there is an open wound commu- nicating with the broken ends of the bone. They are to be treated, in an emergency, like simple frac- tures in the same locations, with the additional precaution that they must be thoroughly cleansed and kept clean, and the greatest care exercised to Fig. 5, FRACTURES BROKEN BONES. 53 keep the sharp edges of the bone from doing any- further damage. In all fractures cloths dampened in cold water may be applied to the surface, so as to prevent, as far as possible, the swelling which usually comes on soon after a fracture, and which often interferes very much with the examination of the surgeon. Splints. There is nothing in which there is a greater call for ingenuity and fertility of resource than in extemporizing splints for broken bones. Pasteboard, leather, shingles, pieces of cigar box — anything fairly smooth and stiff, may be used. A surgeon at the seashore got himself no little credit once by setting a broken arm on the beach, folding up and using as a splint a large newspaper which he had been reading. The chest usually serves as a very good splint for the arm ; and when a leg is broken, the other one will make a good temporary splint, or a coat-sleeve, or leg of a pair of trousers, stuffed with grass or hay, may prove serviceable. 54 ACCIDENTS AND EMERGENCIES. Wounds. In studying wounds we will adopt the classifica- tion customary in works on surgery, viz. , contusions, contused, lacerated, punctured, poisoned, incised and gunshot wounds. Contusions are what are usually known as bruises, and almost all wounds of the soft tissues caused by blows. They are sometimes very painful, and often followed by discoloration, due to the escape of blood under the skin from the small vessels of a part. A black eye is a familiar example of this sort of an injury. They are sometimes very simple, as in the illus- tration just given. Such contusions are best treated at first, when painful, by the application of cold, wet cloths. Pure laudanum is often a very accept- able application. Later, when the pain has subsided, hot, wet cloths are best, as they favor the carrying off of the blood that has escaped. Contusions of the chest or abdomen may be very serious, for beside the external bruises, important internal organs may be injured. Evidence of this may be seen in spitting of blood or vomiting it, or passing it from the bowels or from the bladder ; or there may be great depression. In such cases little WOUNDS. 55 can be done by the non -professional person beyond securing complete rest and sustaining the strength of the sufferer by means of warmth applied externally and careful stimulation internally, as described in speaking of Shock — to which reference may be made (page 66), Contused wounds. These are cuts or tears accompanied with bruising of the tissues. They are to be treated like lacerated wounds. Unless they bleed freely, warm applications are better suited to such wounds than are cold ones. Incised wounds, or clean cuts, if simple and small, call only for a piece of sticking plaster, and perhaps a bandage. If large, the edges should be brought as near together as possible, and supported so by sticking plaster, or bandages, or the hands, till the coming of the surgeon. If an entire part be cut off, as an ear, or a nose, or a toe, or a finger, it should be cleaned with lukewarm water, and put in its place, leaving to the surgeon the decision whether or not it be worth while to try to save it. Some very remarkable cases of reunion of such parts are on record, and an attempt to save them is not to be lightly rejected. Cuts of the walls of the abdomen are often followed by escape of a portion of the bowels. These, if dirty, should be cleansed, and a gentle effort made to restore them to their place. If this fails they should be covered with a clean white cloth, soaked 56 ACCIDENTS AND EMERGENCIES. in warm water and kept warm and wet by a gentle stream of water, or by laying on it a sponge soaked in warm water, which should be constantly renewed. Cuts of the chest wall may be followed by escape of a portion of lung. This should be treated in the way just described for escaped bowel. Cut-throat wounds usually require, in addition to the ordinary treatment of the wound, that the head shall be bent forward, with the chin close to the breast bone, and kept there. The way to wash delicate structures, such as the intestines, or raw cut or torn surfaces, may be described here — and it is a good plan to learn to do such things by practicing them before the emergency arises. Dip a sponge in water, and hold it in the closed hand, with the thumb uppermost, and a corner of the sponge hanging below the fist. Now, on squeezing it regularly, a single stream of water will flow softly and steadily down from it. The size of this stream can be regulated by the way the sponge is squeezed ; its force, by the height to which the sponge is raised. This is the only way of cleaning off delicate tissues that is safe in the hands of the unexpert. Lacerated wounds are tears with ragged edges, such as are often caused by machinery, bricks, clubs, timbers, stones, dull tools, glass, hooks, etc. These always require surgical skill. Till it can be ob- tained, however, the torn parts can be placed in as WOUNDS. 57 nearly their natural position as possible (after re- moving, with a stream of lukewarm water, squeezed from a sponge, any foreign matters that can be so gotten rid of) and covered with a cool, wet cloth, or a cloth soaked in laudanum, or alcohol. If the tear has been very great, and the sufferer is depressed and cold, teaspoonful doses of brandy or whisky, in hot water, may be administered, and a cloth wrung out of hot water placed over the injured parts. Punctured wounds are made with sharp- pointed objects, like arrows, pins, needles, tacks, fish-hooks, glass, thorns or splinters. Of these Pin wounds rarely do much harm. If a needle is run into the flesh and comes out, always see that it is all there ; and if any part, from point to eye, is missing, call a surgeon. Meanwhile keep the wounded part perfectly still, and make no attempt to remove what remains. This would pro- bably be quite in vain, and would only increase the difficulty of the surgeon's work when he arrives. The broken needle should be carefully kept and shown to him, as he will then know better what to look for in his examination. A fish hook is a disagreeable thing to get in one. If this should happen, the best thing to do is to cut off the string, push the point of the hook through, and draw it out, like a needle in sewing. If it can be done, the broad part of the hook may be cut off 58 ACCIDENTS AND EMERGENCIES. before trying this. But this is usually not easy for the operator or the patient. Thorns rarely do much harm unless they are poisonous, and poisoned wounds we shall consider later. Splinters are dangerous in proportion to their size and according to the part they enter. Small splinters may be picked out with a needle. Splinters under the nails sometimes defy at- tempts at removal by the non-medical. But the way to succeed is to scrape the nail as thin as possible over the splinter, then to split it, or cut a little tongue out, and remove the splinter. Often when, after this, the splinter cannot be removed, it will yet come away of itself when matter forms ; and in any case the sufferer will be much better off for submitting to this little operation. Splinters of glass are quite beyond most peopled skill. They are best treated with cold, wet applications, and left otherwise entirely to the surgeon. Splinters in the eye should be pulled out, if possible. If not, the eyelid had better be gently closed, both eyes covered with a layer of cotton soaked in cool water, and a bandage placed round the head, so as to keep the lids as still as possible. This bandage should not be too thick or put on too tight, and the application should be kept cool, with ice, if need be. WOUNDS. 59 If a large splinter enters the body, an attempt may be made to pull it out ; but a surgeon should be called without fail, and whatever of the splinter has been extracted carefully saved and shown to him. This will aid him in making up his mind whether or not the removal has been complete, and perhaps save much pain and danger to the patient. Poisoned wounds may be considered here, as they are usually punctured, and result from the bites or stings of animals or insects. The bites of venomous serpents usually demand the prompt removal of the part bitten. It may be cut out instantly by any one who has the nerve to do it. Before this, perhaps, the part should be encircled, above the wound, with a tight ligature, and, if small enough, thrust into the mouth and sucked hard, so as to extract the poison. The imme- diate application to the wound of hartshorn is of advantage ; and a knitting-needle, or nail, heated to redness, may be thrust into it. At the same time, whisky should be given, in doses large enough to cause drunkenness, and the intoxication kept up till medical aid can be secured. The stings of tarantulas, scorpions, centi- pedes, etc., are to be treated with cold, and harts- horn applied to the point where the sting entered. The stings of insects are rarely dangerous to life. They may be treated with cold, wet applica- tions — wet earth is a very good one. The applica- 60 ACCIDENTS AND EMERGENCIES. tion of a drop of hartshorn or some wet salt often gives great relief. The bites of cats and rats are sometimes fol- lowed by severe inflammation ; but the first treatment should be simply cleansing the bites, sucking them, perhaps, and applying cold to them for a time. The bites of dogs are a terror to many people, while others have little fear and are very seldom bitten. Dogs seem to learn who do not fear them. If any one be bitten by a dog in good health, only the simplest treatment will be necessary. If the dog be sick, local inflammation, or severe constitutional disturbance may follow. In case of reasonable sus- picion, the wound may be thoroughly cleansed and an application of hartshorn made to it, in addition to energetic sucking to extract any irritating material which may have entered it. Of course, too, sound medical advice will be taken. It is a most foolish thing to kill a dog that has bitten anybody, soon after this has taken place. Such a dog should be caught and kept under the observa- tion of a person of great carefulness, intelligence and special information. The too speedy slaughter of a dog has robbed many a sufferer of the assurance that would have been gained by seeing it living and well, and sent many a one to the grave, as dying of hydro- phobia, who never had it, but had been bitten by a healthy and harmless animal. Again, if one has been bitten, and there be a rea- WOUNDS. 61 sonable suspicion that the dog was "mad," let him not despair. Some of the most able and careful (that is the greatest matter) medical men are of the opinion that most, if not all, cases of so-called hydro- phobia, are spurious ; that is, they are not hydrophobia at all. I have myself studied this subject with great care for years, and have become satisfied that the popular theory in regard to hydrophobia is utterly wrong. In most of the reported cases the patients have been alarmed by what they thought, and frightened by what injudicious friends or timid doctors have said and done, until they died of sheer terror. So, in case of a bite from a supposed mad dog, let the things suggested above be done ; then let quiet be secured, and the very best medical man in the place sent for. It is a very serious matter, and calls for the clearest head and most extensive in- formation. Whoever gets flurried and shows alarm at such times is scarcely less dangerous than the dog that did the biting. Then let no one breathe "hydrophobia," or talk about what has happened. By this the chances of escape will be increased.* Gunshot wounds. This is another class of injuries occasionally met in civil life, though not common. Ordinarily little can be done for them, * The author calls attention to the fact that so-called hydrophobia exists exactly in proportion to the common belief in it. It seems to have disap- peared from Pennsylvania, and is extremely rare in any part of the United States. 62 ACCIDENTS AND EMERGENCIES. except by a surgeon ; and perhaps all that is advisable before he comes is to note and remember the posi- tion of the body or the wounded part at the moment it was struck, and the direction from which the missile came, so that these facts may help the surgeon in his search for it.* Then col4 wet cloths, upon which laudanum may be poured, should be kept upon the wound, to prevent, as far as possible, inflammatory swelling ; and if, as is very often the case, the patient be in what surgeons call a state of shock — that is, cold and depressed — stimulating doses of wine, whisky or brandy should be given, and heat applied to the surface of the body. If a part is badly shattered, the local treatment should be the same, except that, if there be much depression, cold had better not be used at all. There is rarely much bleeding from gunshot wounds, except when large vessels are divided. In such a case the bleed- ing may be controlled as described under the head of hemorrhage. * To show how strange may be the course of a bullet, I will cite a case which I treated in 1876. A young man was shot with a pistol. The ball passed through his lower lip, struck an upper front tooth, which it broke off, then glanced downward and backward, diagonally through the tongue, and finally buried itself in the floor of the mouth, on the other side from that where it entered the lip. RAILROAD AND MACHINERY ACCIDENTS. 63 Railroad and Machinery Acci- dents. Railroad and machinery accidents may be the occasion of simple incised, contused or lacerated wounds, or, as is very common, of severe tears, wrenching off of fingers or toes or limbs, or of crushes. Saws, planing machines, cog-wheels, belts, and many other machines or parts of machines, cut or tear off many a limb or part of one. Such injuries almost always occur when no medical aid can be obtained for some time, and it would be well if some one on every train and in every room or place where machinery is in motion could have some idea of what can be done, and what cannot, before a doctor can be had. Trifling injuries, whether cuts or tears, are to be treated on the principles already described in speaking of incised or lacerated wounds ; that is, the parts are to be cleaned as gently and as well as possible, by letting lukewarm water run over them. Then, any displaced tissue — skin or flesh — may be put in place, and a clean, white cloth, soaked in laudanum or alcohol or water, laid upon the wound, 64 ACCIDENTS AND EMERGENCIES. and bound on loosely with an extemporized band- age. Hemorrhage is not usually severe after railroad and machinery accidents, because the wounds are generally inflicted in a way which closes up the blood vessels as they are torn or twisted off. Large tears, or lacerations, must be treated by carefully removing any fragments of clothing, or dirt or splinters of any sort, and washing with luke- warm water. For removing foreign matters, the best forceps are in everybody's possession. They are a finger and thumb ; and no one need be afraid to use them with reasonable care. They may be aided occasionally by touches with a clean linen or muslin cloth, or a clean sponge; but these must be un- doubtedly clean. After cleansing is complete, the torn parts must be put in position, and kept so by bandages, sticking plaster, or the hands of another person, as may seem best. Sometimes a splint is required. This is usually easy to prepare in a mill or on a railroad. It may be clumsy — that is not of much consequence — but it ought to be sufficiently large to keep not only the injured part still, but, in case of a limb, the joint above and the joint below the injury. Such injuries are often accompanied with com- paratively little pain. If, however, there should be severe pain, laudanum may be given — about thirty drops to an adult. Cold or hot cloths — whichever RAILROAD AND MACHINERY ACCIDENTS. 65 are most comforting — must be applied to the injury. When fingers or toes are crushed they ought to be washed, modeled into good shape, dressed with a piece of soft white cloth which has been wrung out of hot or cold water, and laid upon a small splint. If a finger or toe hangs by a mere shred, snip it off entirely. Because, although such fingers and toes have been saved, such a result' is almost miracu- lous, and the cost, in time and trouble and money, is more than a finger is worth to a workingman, and indeed to almost anybody. When fingers or toes are torn off the stumps almost invariably require a scientific amputation. But, until this can be decided upon, they must be cleansed, and treated with a cool, wet application of some sort, and then not meddled with. Hands or feet that have been crushed must be treated by being wrapped up in some soft warm dressing, like cloth, or cotton, or wool. Cold is only to be used if there be profuse bleeding. The injured part must invariably be supported with some sort of a splint and placed about on a level with the body. One who has received such an injury ought to be made to lie down, unless some other course is absolutely necessary for moving him, or is authorized by a surgeon. Such injuries rarely cause much pain, but they almost invariably cause great depression. This must be met by keeping the sufferer warm with 66 ACCIDENTS AND EMERGENCIES. wraps and hot cans or bricks, or bottles, and giving him, every few minutes, a small quantity of whisky or brandy (a teaspoonful) in a little hot water. Larger doses of spirits are not needed. (See Shock.) When hands or feet have been torn off or cut off with wheels, the stumps are to be treated as described, and the limb placed in such a position that the injured point is higher than any other. These injuries are usually accompanied with depres- sion also, and this is to be combated in the manner just described. Crush of the arms or legs is to be treated like crush of the hands or feet. But here the prostra- tion is usually much greater and the need for sup- port, with warmth and stimulants, more urgent. The clothing should on no account be disturbed, except in so far as it can be cut away and replaced with warm coverings. Crushes of the chest are sometimes instantly fatal, and almost always cause death in a short time. In such cases, as well as in case of Crushes of the lower part of the body, there is nothing that can be done beside securing rest, warmth and moderate stimulation. The sufferer should be made as comfortable as possible, and prepared for the almost inevitable issue. Shock is a condition which has been alluded to already, in speaking of certain injuries. It may also be caused by fright, as, for example, that which RAILROAD AND MACHINERY ACCIDENTS. 67 may accompany a trifling gunshot wound. Or it may be caused by a blow upon the pit of the stomach, or by a sudden and severe pain, or even by drinking a large quantity of ice-cold water. It is very com- mon after gunshot wounds, and almost invariable after serious railroad or machinery or mining acci- dents. The signs of shock are : great paleness, a cold, clammy skin, a very feeble pulse and feeble breath- ing, a pinched face, dull eyes, drooping eyelids, dilated pupils, bewilderment or dullness of mind, or even insensibility. A person in such a state may die very soon, and will surely die before long, unless he can be brought out of the shock. This requires prompt, energetic and persistent effort on the part of those who come to his assistance. Heat must be ap- plied, if possible, to the whole body, and especially to the region of the heart and pit of the stomach. This can be done with a hot bath, a hot fire, hot cans, hot bottles, stove plates, heated blankets — in fact, anything hot that can be got hold of. At the same time hot drinks, to which brandy or whisky has been added, may be given in small and frequently repeated quantities. To be more exact, a teaspoonful of brandy or whisky in a tablespoonful of hot water may be given every ten minutes for several hours. Manufactories, mines and railways ought to be furnished with appliances for the treatment of this 68 ACCIDENTS AND EMERGENCIES. condition and some one who knows how to use them ; for shock almost always follows severe accidents oc- curring to their employees, and is the most common cause of death after them, as any hospital surgeon could testify. HEMORRHAGE — BLEEDING. 69 Hemorrhage — Bleeding. There is no accident so appalling as hemorrhage, whether the bleeding comes from an external wound or from the rupture of blood vessels in some internal organ. There is none which calls for so much nerve in combating it, nor any in which a little accurate knowledge can be more valuable. The subject of the control of hemorrhage will be better understood after taking a concise view of the anatomy of the organs of circulation. This cannot be made absolutely accurate without being too techni- cal, but the variations from accuracy will not affect its practical utility. (See Frontispiece.) The blood starts from the left side of the heart, and is driven first into the aorta, which curves over above the heart and descends along the left side of the spinal column, within the chest and abdomen. From what is called the arch, at the beginning, are given off the vessels which supply the head and arms. The former (the carotid arteries) run up alongside the windpipe and divide and subdivide in all direc- tions. The latter curve forward and come out from the chest over the first rib, and, passing under the collar bone near the shoulder, run down through 70 ACCIDENTS AND EMERGENCIES. the armpit and inside of the arm to the middle of the front of the elbow, and here divide into two branches. One of these passes along the front of the forearm, on the thumb side, and the other along the little finger side. Thus, in the upper arm the arteries follow nearly the same line as the seam in a coat-sleeve. The two arteries of the forearm, entering the palm of the hand, join in a loop, from which vessels run down, one on each side of each finger, and one on the inner face of the thumb. The aorta, as it descends through the chest and abdomen, gives off vessels to supply the internal organs, and near the lower end of the backbone divides and sends two large vessels out through the groin into the thigh. Each of these runs down in almost a straight line, between the muscles, to the middle of the hollow at the back of the knee. Just below this it divides into three branches. The first of these passes through to the front, between the two bones of the lower leg, and runs down under the muscle, close to the outer side of the shin bone, and passes out upon the instep at about the middle of the front of the ankle joint. Here it breaks up into smaller vessels that supply the top of the foot. The second and third branches of the main artery of the thigh pass down the back of the lower leg, one on each side, close to the corresponding bones,. and deep under the muscles. One passes back of the HEMORRHAGE — BLEEDING. 71 inner ankle bone into the inner side and sole of the foot. The other passes back of the outer ankle bone, to the outer side and sole of the foot. The arteries of the sole of the foot, like those of the palm of the hand, unite to form a loop, from which a vessel is given off for each side of each toe. This is a brief outline of the course of the arteries. As they divide and subdivide, like the branches of a tree, they become correspondingly smaller, and they end in an inexpressibly fine network of minute ves- sels. These are called capillaries. Then, as the capil- laries are a sort of splitting up of the smallest arteries, so, on the other hand, by the confluence of a number of capillaries, larger trunks result, toward which the current of blood constantly sets, and the beginnings of the veins are formed. These unite in a manner the very reverse of the branching of the arteries, and, growing, like rills and brooks and rivers, larger and larger by repeated junctions of several into one, travel back to the heart in an opposite direction to, but alongside of, the arteries. Thus each principal artery has at its side at least one important vein. Up the legs, up the inside of the abdomen and chest, up the arms and down the neck they pass, till they unite to form one trunk, which empties into the right side of the heart. From this point the blood is pumped into the lungs to be aerated ; from the lungs it is collected and emptied into the left side of the heart ; and 72 ACCIDENTS AND EMERGENCIES. from the left side, as we have seen, it is pumped out to begin the circuit through which we have just traced it. The diagram in the frontispiece will give a fair idea of the course of the main blood vessels, and will make clearer what may not have been under- stood from the preceding description. It will be observed that the course of the blood vessels is always in the safest part of the body or limb. They all lie where they are protected by bending a limb or a joint — a natural act when attacked. They are on the inner side of the arm and forearm, when these are used for attack or defence. They are on the inner side of the thigh and at the back part of the leg — out of harm's way. In endeavoring, as shall hereafter be recommended, to check bleeding by pressing upon a main blood vessel, this fact may serve as a reminder of the course it might be expected to run. To which this suggestion may be added, namely : When you are in doubt, feel for the pulsation of the artery and make pressure where you feel it beating. Another point, preliminary to considering the methods of arresting hemorrhage, is that blood from arteries is usually bright red and escapes in jets, while blood from veins is dark red or purple, and flows in a steady stream. Blood from capillaries is of a color between these two, and it oozes out. Capillary hemorrhage follows every cut. The HEMORRHAGE — BLEEDING. 73 color of the blood is red ; the flow is generally slow and not very considerable. It usually stops of itself. If it does not, the part may be elevated and cold water or ice or snow, or even vinegar, applied. If there is oozing from a large raw surface, a towel may be folded, dipped in water as hot as the hand can possibly bear, lightly squeezed, so as not to drip, and gently pressed upon the bleeding surface. This may have to be renewed once or twice, at intervals of a few minutes, but it usually acts like magic in this form of hemorrhage. Hemorrhage from the veins is generally slow and steady, and the blood is darker than in other forms. It rarely demands special effort to control it. When severe, the application of cold, and firm con- tinuous pressure upon and below the wound, generally suffice to stop it. Rupture of varicose veins in the leg may lead to dangerous hemorrhage, but this can usually be checked by applying a dry pad of cloth and binding it firmly down upon the bleeding spot. In this case a ligature applied above the wound would only make the matter worse. A wound of the jugular vein, on the side of the neck, may also be followed by dangerous hemor- rhage. This is also to be treated with a pad and pressure, which can be best made with one finger laid above and one below the wound. Hemorrhage from the arteries is very danger- ous. Here the blood is bright red, and spurts in a F 74 ACCIDENTS AND EMERGENCIES. stream or leaps in jets from the divided vessel. If it be from a large artery, such as those in the root of the neck or the armpit, or the inside of the thigh near the groin, life will usually be quickly lost. Indeed, without a thorough acquaintance with anatomy, it is hardly likely that any advice that could be given here would be available in such cases. The only thing to suggest is to thrust a finger deep into the wound and see if firm pressure there will stop the bleeding. Or some other form of plug may be tried. The chances of success are, however, very slight. But every one may, while awaiting skilled aid, do something when the arteries of the limbs are cut. The first duty in all such cases is to be cool as pos- sible, then, as quick as is consistent with coolness. The principle that must guide every attempt to stop the bleeding is to obstruct the artery at the spot, or between the centre of the body and where it is cut ; for this is the direction in which the blood flows. For wounds high up in the arm, strong pres- sure may be made downward, behind the collar bone, about at its middle (see Fig. 7). The thumb, or the handle of a large door key, well wrapped, so as to make a tolerably thick mass, can be thrust down, and if it does not seem to strike the artery the first time, it can be moved along, toward the breast bone and toward the shoulder, to see if it will hit the right place. HEMORRHAGE — BLEEDING. 75 For wounds of arteries of the finger, pres- sure may be made on the side, by seizing it between the thumb and finger and pinching it, or by wrap- ping a cord round, or slipping on a rubber band. For wounds of arteries of the hand, raising this above the head and making firm pressure on the bleeding spot, or with both thumbs just above and in front of the wrist, will usually stop the bleeding. Or the wound may be packed with lint, or cotton, or old muslin, or linen, and bound firmly with a band- age. If this fail, resort must be had to the measures recommended for the next form of hemor- rhage. For wounds below the elbow, first grasp the upper part of the arm with both hands and squeeze as hard as possible ; then let some one make a thick, hard knot, as big as an egg, in the middle of a hand- kerchief, place it over the middle of the front of the arm, immediately above the elbow, tie the ends tight at the back, and bend the forearm up so as to press hard against the knot (Fig. 6). This, if successfully done, will obstruct the main blood vessel (the brachial Fig. 6. artery), which in this place lies in the middle line of the bend of the elbow. 76 ACCIDENTS AND EMERGENCIES. For wounds in the upper arm, pressure may be made against the bone on the inner side and just below the swelling muscle, which most people are aware is called the biceps, as shown in Fig. 7. A knot as big as a fist may be made in any piece of cloth and shoved hard up into the armpit, and the elbow then brought straight down and held or bound firmly against the side of the chest. If either of these methods fail, or can- not be carried out, the " Spanish-windlass ' ' may be used. To do this, place some hard, round body, like a stone, in the large part of a handkerchief folded diagonally, and carry the ends of this round the limb, so as to leave the lump over the position of the artery — that is, over the bend of the elbow, or a little in front of the middle of the inside of the arm, near the shoulder. Then tie the ends of the handkerchief so as to make a loose loop, slip a stick through this and twist it round and round, so as to tighten the Fig. 7. HEMORRHAGE — BLEEDING. 77 handkerchief, till the blood stops flowing but no more / This is a much rougher procedure than the method described before, but one cannot be over-particular in such cases ; so if the former fails, or no bystander is cool enough to carry it out, -no time must be lost before the " Spanish-windlass ' ' is used. Wounds of arteries of the foot or leg may be treated by firm pressure in the hollow just behind the knee (above the calf of the leg). This can be effected by placing there a knotted cloth, like that sug- gested for the armpit, and doubling the leg back until it presses hard against it. In doing this, the thigh must be doubled up toward the abdomen or the bending of the knee will soon become intolerably painful. For wounds in the thigh, pressure must be made in the hollow imme- diately below the groin, about two-thirds of the way from the hip bone to the middle line of the body, where the artery of the thigh (femoral artery) comes out of the body, as shown in Fig. 8. FlG 8 78 ACCIDENTS AND EMERGENCIES. This can be effected with the thumbs or with a rounded stick, or a key handle, or with a " Spanish-windlass.' ' The artery may also be closed by placing in the groin a knotted cloth, or a large round stone, and doubling the leg back on the thigh (this is important), and the thigh forward, hard against the abdomen. If this latter plan does not succeed promptly some other one of those mentioned should be tried, and no time be lost in doing it. Bleeding from arteries of the scalp can be controlled by firm pressure upon and around the bleeding point. Recapitulation. — To go over this briefly again ; Re- member : first, to keep cool ; second, that the princi- pal object is to obstruct the artery above the cut ; and that this can be effected by pressure, in the several cases, in front of the bend of the elbow, in the armpit, behind the bend of the knee, or just below the groin. This can be made with the fingers, or with a knot, held hard against the artery by a tight bandage, or by bending the limb up against it — or, in case of the arm, by pressing it hard against the chest. In case of failure, the " Spanish-windlass ' ' is to be applied to the same places. In case none of the plans proposed can be carried out, a cut that bleeds profusely may be stuffed with a rag or dry earth, and this kept in place by pressure, with a bandage or handkerchief, or the cut part may be forcibly compressed in any way, or a finger thrust HEMORRHAGE — BLEEDING. 79 into the wound and held wherever it seems to do most good. Finally, let it be remembered that fainting may put an end to hemorrhage, and that when con- sciousness is restored the bleeding may recur. So this possibility should not be overlooked. The treat- ment of a faint under these circumstances is the same as that of any faint : in addition to the measures demanded to check the bleeding, the head must be lowered, the legs and arms may be elevated, and warmth applied to the body, while stimulants are carefully administered by the mouth. 80 ACCIDENTS AND EMERGENCIES. Special Hemorrhages. Bleeding from the nose is often only Nature's way of getting rid of an excess of blood ; but it may be so profuse as to threaten life. If this be the case, of course, medical aid will be summoned ; but until it arrives the best thing that can be done is to snuff salt and water, or vinegar, up the nose. A strong solution of alum in very warm water is also useful ; but vinegar is less disagreeable, and will rarely fail to check the bleeding, unless the case is beyond any except skilled help. In hemorrhage from the lungs the blood is bright red and generally frothy. It is rarely pro- fuse, and yet, as it is usually coughed up and caught in a handkerchief, it seems to be so. The amount can never be safely estimated in this way. The best treatment is rest in bed, with the body raised in the sitting posture, and the swallowing of lumps of ice. The application of cold to the chest, if the patient is not too weak, is of some use, and a saltspoonful of salt and a teaspoon ful of vinegar may be given every fifteen minutes. In hemorrhage from the stomach the blood is usually very dark, looking like coffee grounds. SPECIAL HEMORRHAGES. 81 If it is mixed with any other contents of the stomach, its appearance may be masked. In such cases ice water or broken ice may be swallowed, and tea- spoonful doses of vinegar. Rest in bed must, and the application of cold to the stomach may, be em- ployed. Hemorrhage from the bowels may be treated with ice-water injections and the application of ice to the abdomen. In internal hemorrhage ice-cold cloths may be placed upon the abdomen. Rest in bed, with- out a pillow, and with the head lower than the body, must also be secured. 82 ACCIDENTS AND EMERGENCIES. Transportation of Injured Per- sons. If injured persons have to be removed from one place to another, it is worth while to know how to do it with the greatest ease and safety to them. If a door, or shutter, or settee is at hand, any of these will make a good litter, with a blanket, or shawls, or coats for pillows. In placing a person upon a stretcher it should be laid with its foot at his head, so that both are in the same straight line. Then one or two persons should stand on each side of him, and, raising him from the ground, slip him up on the stretcher. This can be done smoothly and gently, whereas, if a stretcher is laid alongside of an injured person, some of those who lift him will have to step backwards over it, and in doing so are very apt to stumble. In going up hill the patients head should be in advance, in going down hill, his feet. If a limb is crushed or broken it may be laid upon a pillow, with bandages tied round the whole, so as to keep it from slipping about (see page 50). Where an injured person can walk, he can get much help by putting his arms over the shoulders and round TRANSPORTATION OF INJURED PERSONS. 83 the necks of two others. In case of an injury where walking is impossible and lying down is not abso- lutely necessary, an injured person may be seated on a chair and carried, or he may sit upon a board or fence rail, the ends of which are carried by two men, around whose necks he should place his arms, so as to steady himself; or two men may carry him seated Fig. 9. Fig. 10. on their interlocked hands, in the way known to children as "Lady to London.' ' To do this, each of two persons, standing face to face, should grasp his right forearm with his left hand (its back upper- most), then he should grasp his companion's free left forearm with his own free right hand (also with its back uppermost), as shown in Fig. 9. When no 84 ACCIDENTS AND EMERGENCIES. litter can be gotten, the body may be supported by a man on each side, with their arms placed behind his chest and under his hips, as in Fig. 10. In carry- FlG. XI. ing an injured person upon a litter, or what serves for one, the bearers ought not to keep step ; but when they are not using a litter, they should keep step. \ poisons. 85 Poisons.* Immediately upon the discovery or suspicion of poisoning, some one should be dispatched for a doc- tor, if possible, carrying information as to the poison taken, so that valuable time may be saved. Mean- while the following may be done : — i. Unknown Poisons. If the patient should vomit, this should be encouraged; if not, it must be provoked. The simplest way to do this is to give large draughts of lukewarm water, and thrust a finger down the throat. If there be time, and it is at hand, a teaspoonful or two of ground mustard may be stirred up in the water, or a teaspoonful of powdered ipecac, or a tablespoonful of the syrup of ipecac. Further, let it be remembered that there is no occasion for fastidiousness. Any water will do. Water in which hands — or dishes, for that matter — have been washed, may, by its very repulsiveness, act more quickly than anything else ; and if soap has been used, it will be all the better for that, as soap * It is better to prevent accidents than to correct them. It is a good plan to have dangerous articles kept invariably out of reach of children, and to have any bottle containing what may be dangerous marked by a ball and chain, such as the druggists sell, or by tying a stout piece of tape round its neck. This gives warning in the dark as well as in the light. 86 ACCIDENTS AND EMERGENCIES. is an antidote for acid poisons. The quantity used must be large ; the sufferer must be urged to drink and drink, a large quantity at a time, until he can contain no more, and has been made to vomit over and over again. After copious vomiting, soothing liquids should be given — oil, milk, beaten-up raw eggs — all in moderately large quantities. These are especially valuable when the poison has been of an irritating character. If the sufferer be much depressed in body or mind, the hands and feet cold, the lips blue, the face pale, a cold perspiration upon the forehead and about the mouth, then some stimulant may be administered. Strong, hot tea, without milk, is the best, because it is a chemical antidote to many poisons. Strong coffee is next in value. To either of these can be added brandy, whisky, wine, or alcohol, in tea- spoonful doses for an adult, and half as much for a child ; the spirits should be mixed with a little hot water. Warm coverings are not to be forgotten ; and if the depression be great, hot water cans or hot bricks, wrapped in one or two thicknesses of blanket, should be laid by the side of the chest, or a huge poultice placed round the body, or a blanket, wrung out of hot water and covered with a dry one. 2. Acid Poisons. Oil of vitriol (sulphuric acid) and nitric and muriatic acids are heavy, sometimes yellowish-looking, fluids ; the first, as its name im- poisons. 87 plies, not unlike oil in appearance, but very heavy in a bottle. The others are lighter, and give off extremely pungent, irritating fumes. All discolor anything on which they fall ; the first blackens white pine wood, the others turn it yellow. All burn hor- ribly and leave no doubt of their caustic nature. For these the proper treatment is to give an alkali. A tablespoon ful of hartshorn may be mixed with two teacupfuls of water, and given ; or almost unlimited quantities of soda, magnesia, potash, whitewash, chalk, tooth powder, whiting, plaster, soap, or even wood ashes, stirred up in water. After this should come the provoking of vomiting ; then the bland fluids mentioned above should be ad- ministered, rest secured and stimulation employed, if necessary. Oxalic acid comes in small, heavy, bright, color- less crystals, making a clear rattle in a bottle or jar. For this the best antidote is lime in some form. If lime water is at hand, it may be given freely, or whitewash, tooth powder, chalk, whiting, or plaster from a wall. The latter may be crushed and stirred up in water, without regard to the grittiness, which will not do any harm. Carbolic acid is usually in solution, as a thick, clear and dusky fluid. When taken by the mouth it causes whitening and shriveling of the mucous membrane lining it, with intense burning and then numbness. There are also nausea, weakness and 88 ACCIDENTS AND EMERGENCIES. depression, sometimes actual collapse. It is a very dangerous poison, because it acts rapidly and be- numbs the stomach, so that it is hard to provoke vomiting. This must be attempted, however, and large draughts of oil, white of egg, magnesia and water, or milk must be given. Rest, warmth of the body and stimulation must also be secured. 3. Alkaline Poisons. The strong alkalies are ammonia, or hartshorn — which is a clear fluid with an unmistakable odor— potash and soda, usually dis- solved, and sometimes in the form of lye. Liniments sometimes contain these substances, and are swal- lowed by mistake. The alkalies usually burn intensely. They must be combated with an acid. Vinegar can always be had, and there is nothing better. It should be given undiluted, and a pint at a time, if possible. Lemon juice may be used, or even orange juice, though the latter is too mild an acid to be of much service, unless the oranges are very sour. Vomiting should then be provoked, and followed by bland acid or oily drinks, rest and stimulation, if necessary. 4. Metallic Poisons. Arsenic, sugar of lead, corrosive sublimate and tartar emetic are not infre- quently taken by mistake, because they are used for various household purposes. Arsenic comes as a white, sweetish powder, often used to destroy domestic pests, such as rats and roaches. It usually excites vomiting and violent poisons. 89 pain in the stomach. At once large quantities of milk, white of egg, or flour and water, or oil and lime water must be given. The vomiting must be en- couraged or provoked, and dialysed iron given. This can now be obtained at any drug store, and should be given freely, in tablespoonful doses, each dose being followed at once by a teaspoonful of common salt in a teacupful of water ; or, if this is not at hand, equal parts of sulphate of iron (green vitriol) and of carbonate of soda may be dissolved in separate cups of hot water and then mixed and drunk. Afterward vomiting should be again pro- voked, followed by a dose of castor oil. Paris green is an arsenical preparation. If taken as a poison, it must be treated like simple arsenic. Sugar of lead comes in white lumps or powder, and calls for vomiting, Epsom salts, milk, eggs, and castor oil. Corrosive sublimate comes in small, colorless crystals, or in a clear solution. If taken, vomiting must be provoked, and some form of tannic acid given. Strong tea is the handiest thing containing this, and its administration should be followed up with eggs and milk. Tartar emetic, a white powder, is best treated in the same way. Phosphorus is sometimes chewed off of matches by children. It is a poison which acts slowly, and affords ample time for securing medical advice. But G 90 ACCIDENTS AND EMERGENCIES. five-grain doses of sulphate of copper, dissolved in water, may be given, at intervals of ten minutes, until vomiting comes on. Then a dose of magnesia should be administered ; but no oil Lunar caustic is sometimes swallowed. The antidote of this is a very strong brine of salt and water, given again and again; and vomiting should be provoked, until the vomited matters cease to have a look like thin milk. Iodine, in the form of a tincture, is also some- times swallowed by mistake. The antidote for this is starch and water. 5. Vegetable Poisons. The vegetable poisons are so often taken in consequence of mistakes in the use of medicines, that it is a wise precaution that a poisonous drug should always be contained in a bottle of peculiar shape, or with something peculiar attached to its neck, and that there should also be a special place in each house where dangerous reme- dies, and such as are intended only for external use, should be kept. Opium preparations are opium, morphine, laud- anum, paregoric, black drop and many poisonous nostrums sold as soothing-syrups, pain-destroyers, and drops for infants. Their symptoms are deep sleep, with narrowing of the pupil of the eye to a small circle, which does not enlarge in the dark. Here emetics must be used promptly and persist- ently, and vomiting produced over and over again. POISONS. v 91 Strong coffee must be freely given as a stimulant. So long as the breathing does not fall below ten to the minute, there is no immediate danger of death ; but opium is a treacherous poison, and requires all the skill that can be obtained to combat it. The important matter is to keep up the breath- ing. The custom of walking a patient up and down and slapping him with wet towels is to be deprecated, because it adds exhaustion to stupor. If an electrical battery can be obtained, and used, it is the best thing that can be done. The Faradic current should be used, and applied so as to stimulate the sensory nerves in the skin, so that they shall excite reflex acts of deep breathing. The next best thing is to lay the patient upon a lounge and slap his skin with the back of a broad brush or with a slipper. This is all the rousing that is necessary, so long as the breath- ing keeps above ten to the minute. Should it fall below this, or if the breathing should cease, artificial respiration should be employed. (See pages 13-15.) Chloral is a damp, colorless, crystalline substance, usually seen in solution. Its symptoms and treat- ment are the same as those of opium. Strychnine is an intensely bitter, white powder. It produces stiffness of the jaws, then of the limbs and body. It should be treated by provoking vomit- ing, giving a purge, and doses of thirty grains of bromide of potash, or twenty grains of chloral, or 92 ACCIDENTS AND EMERGENCIES. both, to an adult. The greatest quiet must be secured. The poisoned person should be put to bed in a darkened room, with doors, windows and shutters arranged in a way that shall exclude all sights, sounds and draughts, though permitting good ventilation. Aconite is sometimes contained in liniments, and swallowed by mistake. In such a case vomiting must be brought on, and followed by the adminis- tration of stimulants. Strong coffee may be used, hartshorn (a teaspoonful in a teacupful of water), wine, whisky, or brandy. The patient will often feel a peculiar numbness or tingling in the arms or legs, which is an evidence that the poison has entered the blood, and makes the attention of a phy- sician imperative. If there is depression, warmth should be used, as described wjien speaking of un- known poisons. Hemlock, deadly nightshade, the James- town (or jimson) weed, monkshood, and toad- stools are sometimes eaten, without knowledge of their poisonous character. Tobacco, too, some- times causes poisonous effects. All produce deep depression, and must be treated with vomiting, fol- lowed by stimulation and warmth, very much as in the case of aconite poisoning. Alcoholic liquors are sometimes taken in such large quantities as to be poisonous. When this is the case there are evidences of deep stupor or de- poisons. 93 pression. The course to be pursued is to cause vomiting, give hartshorn and water (a teaspoonful in a teacupful), and keep the body warm. (See page 33. Intoxication?) 6. Decayed meats or vegetables usually excite vomiting, which should be encouraged till the stomach is empty, and followed by a dose of castor oil and some powdered charcoal. Resume. We have now completed the list of poisons that are at all common, and have seen what should be done in almost any case that is likely to occur. In conclusion, let it be remembered that, when there is an alarm of poisoning, some one, at least, must keep cool ; then that a physician is to be summoned (sending him word, if possible, what poison has been taken); and that, until his arrival, the course indicated above should be followed. To save time in an emergency, the following table may be consulted, which gives the name of each poison we have already studied, and the proper treatment for it. POISON. TREATMENT. f Provoke repeated vomiting; Unknown -< Give bland liquids ; (Stimulate, if necessary. Acids — Sulphuric, Nitric, Muriatic, Oxalic, Alkalies — Hartshorn Soda, Potash, Lye, f Give an alkali ; I Provoke vomiting ; -! Give bland fluids ; Secure rest ; ( Stimulate, if necessary. Give an acid (vinegar) ; Provoke vomiting ; Give bland liquids ; Secure rest ; Stimulate, if necessary 94 ACCIDENTS AND EMERGENCIES. POISON. Arsenic- Paris green Scheele" reen, V , 's green, J Sugar of Lead, Corrosive Sublimate, \ Tartar Emetic^ J Phosphorus Lunar Caustic (nitrate") of silver), j Iodine. Opium — Morphine, Laudanum, Paregoric, etc., Chloral, Croton Oil., Strychnine. Aconite, Veratrum Viride } Jamestown Weed, Hemlock, Nightshade (belladonna), Toadstools, Tobacco. Alcohol Decayed Meat or Vegetables. TREATMENT. Provoke vomiting ; \ repeat Give dialysed iron and salt ; j several Give dose of castor oil ; times ; Secure rest ; b Stimulate, if necessary. {Give Epsom salts, \ repeat several Provoke vomiting, J times ; Give bland liquids ; Give dose of castor oil. Provoke vomiting, ") repeat Give strong tea, without milk, J several Give raw eggs and milk ; times ; Give dose of castor oil ; Stimulate, if necessary, f Provoke vomiting ; j Give five-grain doses sulphate of copper; ' j or teaspoonful doses of turpentine. [Give dose of magnesia ; but no oil. f Give strong salt and water, ) repeat ' \ Provoke vomiting, j many times . f Provoke vomiting ; •< Give starch and water ; (Give bland fluids. f Provoke vomiting, repeatedly; A Give strong coffee, without milk ; (Keep up the breathing. f Provoke vomiting; .-< Give bland fluids, ( and laudanum or paregoric. ( Provoke vomiting, once or twice ; .-< Give a purgative ; (Secure absolute quiet. f Provoke vomiting ; . < Stimulate well ; (Keep head low. Provoke vomiting ; Stimulate well. ( Provoke vomiting ; ' ( Give hartshorn and water. ( Provoke vomiting ; A Give a purgative; (Give powdered charcoal. To provoke vomiting, warm water may be used with or without ground mustard (a tablespoonful to poisons. 95 a pint of water), or ipecac (a teaspoonful of the powder or a tablespoonful or so of the syrup), and thrusting a finger down the throat. It is best to give large quantities (that is, a pint at a time) of warm water whenever vomiting is to be excited. Bland liquids are milk, raw eggs, some sort of oil, gruel, etc. Stimulants are tea, coffee, whisky, wine, etc., or hartshorn and water. Of this a teaspoonful in a teacupful of water will be enough for a dose. In making tea or coffee one must not wait to do it as if for. the table, but mix hot water and the leaves or grounds, squeeze them well, stir together, and give the whole — leaves, grounds, everything. At the same time some may be made regularly, if there are conveniences for it. Alkaline antidotes are hartshorn and water (a tablespoonful in two teacupfuls of water) soap and water, lime, whiting, soda, chalk, tooth powder, plaster, magnesia, whitewash, and even wood ashes. Acid antidotes are vinegar and lemon juice. In giving an antidote never wait for it to dissolve. Just stir it up in any fluid at hand except oil, and have it swallowed immediately. When laudanum is advised for such an irritant poison as croton oil, it must be given in a dose of half a teaspoonful to an adult, and this may be repeated in half an hour if the pain continues to be severe and there is no drowsiness. 96 ACCIDENTS AND EMERGENCIES. Domestic Emergencies. No less important than the emergencies thus far considered, most of which have a sort of public significance, are a few more which usually occur within the limits of the household and try the know- ledge and patience of anxious parents. If these emergencies arose only when skilled assistance could be had in a moment, they might, perhaps, be omitted from a book like this. But they have a way of pre- senting themselves at the dead of night, in traveling, at the seashore, or in the mountains, where doctors are not known or are not to be had promptly, and those upon whom the burden of meeting them falls may be glad to have some simple suggestions as to what they may do until they can commit their in- terests to others better prepared to guard them. Cholera morbus produces vomiting and purging and violent cramps in the stomach. The pain may be so severe as to actually threaten life. There is then a pinched expression of the face, and a cool, clammy skin. In such cases, something must be done at once to relieve the pain. For this, laudanum may be given — half a teaspoonful to an adult, or ten drops to a child over twelve years old. At the same time DOMESTIC EMERGENCIES. 97 heat must be applied to the stomach. For this pur- pose a mustard plaster can be used, or cloths wrung out of hot water and sprinkled with turpentine or with red pepper, or a hot-water bag, or bottle, or a plate heated at the fire and covered with a cloth. An injection containing a small teacupful of warm water or milk, to which a tablespoonful of tincture of asafcetida has been added, often gives great relief. Colic causes violent griping pain in the abdomen. It is usually due to something indigestible which has been eaten. It should be treated by hot applications to the abdomen, such as have just been mentioned. A purgative, such as castor oil or ten grains of calomel may be given by the mouth, and an injection of water and asafcetida administered, as described in speak- ing of cholera morbus. Vomiting, or nausea, due to something objec- tionable in the stomach, may be treated by giving large draughts of pretty hot water. If it be due to nervousness or a slight indigestion, it can usually be corrected by swallowing small pieces of ice, or table- spoonful doses of lime water, or a pinch of soda, or half a teaspoonful of aromatic spirits of ammonia in a wineglassful of water, together with the applica- tion to the pit of the stomach of a mustard plaster, or of a flannel cloth wrung out of hot water and sprinkled with a tablespoonful of turpentine or some red pepper. A lump of ice held against the pit of 98 ACCIDENTS AND EMERGENCIES. the stomach often does much good. The sufferer should always lie down until the nausea passes off. Diarrhoea is usually due to a cold or to something indigestible which has been eaten. In either case it is an effort of nature to cure itself of something hurt- ful. So, at the start, the best thing to be done is to give a mild purge. It is a good plan to give a tea- spoonful or two of a mixture of equal parts of olive oil and castor oil to an infant, and a tablespoonful or two to an adult. Half these quantities of a mixture of glyce- rine and castor oil acts equally well. For infants nothing acts better than a tenth of a grain of calo- mel, given every hour or half hour till it produces a free movement. A small dose of equal parts of sweet oil and castor oil, or spiced syrup of rhubarb or magnesia is the best. After this, if the move- ments of the bowels soon return, half a teaspoon ful of ginger in a wineglassful of water may be given to an adult after every passage. If this does not check the diarrhoea, ten drops of laudanum may be given to an adult after each passage. For an adult, also, an injection, made of half a small teacupful of boiled starch, to which thirty or forty drops of laudanum have been added, often gives immediate relief. For a child over two years old half a drop of laudanum may be given after each passage, until the diarrhoea seems checked, or there is some evi- dence of drowsiness. A simpler remedy, which often acts well, is a tablespoonful of raw flour in a DOMESTIC EMERGENCIES. 99 glassful of cool water, to be taken in two doses, half an hour apart. Croup. Attacks of spasmodic croup, though very- alarming, are rarely dangerous. There is probably much less real croup than is supposed, and the hoarse cough which children sometimes have after taking cold, may lead to measures which make it much worse for all concerned. Parents need not get excited when they hear what is called a "croupy" cough. When it occurs, they should first see what can be ac- complished by allaying the alarm of the child, and by diverting its mind. The reading of some favorite story or the exhihition of a favorite toy may cause all the symptoms of croup to disappear. When such mild measures are of no avail, and the symptoms become more urgent, the little sufferer should be given an emetic of a teaspoonful of syrup of ipecac or a heaping teaspoonful of powdered alum, followed by a draught of warm water. Cloths wrung out of water as hot as can be borne should be wrapped round the throat and laid upon the chest. They should then be covered with something to keep the heat in — like oiled silk or a dry cloth. This is all that can ordinarily be done with ad- vantage till a physician arrives. But it usually gives decided relief. In this case, and even if it does not, natural anxiety should not drive parents to be want- ing to do something else all the time. They may renew the hot cloths as soon as they begin to grow 100 ACCIDENTS AND EMERGENCIES. cold, but beside this there is nothing to be done but to wait until there has been time for the spasm to pass off. This is hard to do, it is true ; but it is the best thing to be done, and far better than the fuss and worry, to parents and child, of trying a variety of methods. In Whooping Cough there is a strong nervous element, and a spasm of coughing is often brought on by the example of another child. So, when a child is seized with a fit of coughing, it ought, if possible, to be at once separated from other children, for its own good and for theirs. Then, if the fit does not pass away in the usual time, it may sometimes be cut short by pressing a lump of ice against the chest, or by placing hot cloths there. Asthmatic attacks may be treated in several ways. One method is founded upon the fact that asthma is a nervous manifestation, which grows worse the more the attention is directed to it. If the attention can be diverted the attack will often pass off. Occurring, as it usually does, at night, the darkness, the surprise, the absence of surround- ing activities, increase its effects. If the sufferer be a man, and will get out of bed, put on his gown and slippers, light his gas and take a book or paper and begin to read, he will, in many cases, soon find his trouble diminishing and finally disappearing. If he be a smoker, his cigar or pipe will help him in this emergency. DOMESTIC EMERGENCIES. 101 A less agreeable method is to take an emetic. Another is to smoke the asthma cigarettes sold in every drug store. Another is to get some steaming hot water in a basin, pour into it a tablespoonful or more of Hoffman's anodyne, and breathe the ascending vapors. One of the best remedies is a full dose of opium in some form — for an adult, thirty drops of laudanum, or a tablespoonful of paregoric. As soon as this takes effect the spasm of asthma will disappear. Nervous attacks, which may take the form of shivering fits, are to be treated by putting the patient to bed, if possible, and giving strong hot coffee, or hot sweetened water, and by applying heat to the body by a bath or hot cloths or bottles, with a mild mustard plaster or turpentine placed on the pit of the stomach. A teaspoonful of camphor water, of valerian, or of Hoffman's anodyne, will often prove of great service. Toothache, depending upon a cavity in a de- cayed tooth, is usually very easy to stop. To do this a fine crochet needle should have a very small bit of clean cotton twisted round its point, and with this the hole in the tooth should be thoroughly swabbed out. Then the point of the crochet needle should be cleaned and another little ball of cotton, like a very small shot, should be dipped in oil of cloves and caught up with the end of the needle. It should then be laid in the hollow tooth and pushed 102 ACCIDENTS AND EMERGENCIES. in, not too hard, with the end of the needle. This rarely fails to cure such a toothache. Sometimes filling the cavity with baking soda will stop the pain. When toothache is not due to a hollow tooth, a somewhat severe but usually efficient plan of treat- ment is to lay between the gum and the cheek a little wad of cotton, the size of the end of the thumb, soaked in spirits of camphor. This makes a sort of blister, but generally cures the toothache, which is much harder to bear. Earache should always suggest an examination of the teeth, and if one be found decayed, it must be extracted or at least cleaned out and packed with cotton and oil of cloves, as described in speaking of toothache. For many earaches depend upon diseased teeth. In case this is not called for, or does no good, a folded cloth, wrung out of hot water, with a tea- spoonful of laudanum poured over it, or a big, hot poultice — for which hops is the best material — should be applied to the side of the head and kept as hot as possible. Hot drinks should be given also, and enough laudanum to cause relief from pain. The occurrence of an earache should always lead to consulting a doctor, for it is often of importance as a sign of disease which may seriously affect the hearing. Poisoning by the common poison vine causes red blotches, and wheals, and blisters on the DOMESTIC EMERGENCIES. 103 skin, with great burning and itching. It is best treated by applying cloths soaked in a solution of soda, a tablespoonful to a teacupful of hot water. Dusting with magnesia or ordinary toilet powder is also grateful. Neuralgia of the face may come on suddenly, when the advice of a physician cannot be obtained. In such a case the application of a hot cloth, wet or dry, may do much good, or painting the painful part with oil of peppermint. On the other hand, cold applications may do more good, although this does not often happen. 104 ACCIDENTS AND EMERGENCIES. Signs of Death. In the absence of a physician it sometimes becomes important that others shall be able to determine whether death has taken place or not. The occur- rence of death can be recognized by the following signs: The breathing and pulse cease, the surface becomes pale, the muscles relax, the lower jaw falls a little, the "sight" of the eye becomes dull and glazed, the upper lid falls so as to partly cover the eyeball, then the whole body gradually cools to the temperature of the surrounding air and becomes rigid, while later decomposition sets in, and usually shows itself first by a greenish discoloration of the surface of the abdomen. But it does not require the detection of all these signs to determine that death has taken place. The cessation of breathing and of the heart-beat is a safe basis to an opinion. It requires some care, however, to decide that there is no breathing or circulation. To test the former, a cold piece of polished steel — like a razor blade or table-knife — can be held under the nose and before the mouth. If no moisture condenses upon it, it is safe to say there is no breath- ing. To test the cessation of the heart-beat, it is not SIGNS OF DEATH. 105 enough to feel for the pulse at the wrist. The largest blood vessel in the body (see Frontispiece) runs directly down from the heart, along the left side of the spinal column, and its strong beating can be plainly felt in most people by pressing the finger tips firmly down toward the backbone, at the point below the breast bone called the "pit of the stomach." In this place the slightest pulsation of the heart can be felt if the walls of the abdomen permit the finger to get near the backbone, and here examination should be made before deciding that the heart has ceased to beat. Another test is listening over the region of the heart, in front of the left side of the chest. An acute ear can always detect the move- ment of the heart by sounds made by its valves, which, when perfect, sound like the syllables " ub- dup," "uf-dup," and so on. If careful listening fails to detect the heart sounds, and the cold metal fails to show any evidence of breathing, the individual may certainly be said to be dead. When, in addition to these signs, paleness, mus- cular relaxation, a glazing eye, increasing coldness and rigidity come on, it hardly requires the onset of decomposition — the infallible sign — to prove, beyond any possibility of doubt, that death has occurred. The electrical battery may be used in doubtful cases. Electricity distinguishes with absolute certainty between life and death. Within two or three hours after the stoppage of the heart the whole of the H 106 ACCIDENTS AND EMERGENCIES. muscles of the body will have completely lost their electric excitability. When stimulated by electricity they no longer contract. If, then, when electricity is applied to the muscles of the face, limbs, or trunk, after supposed death, there be no contraction, death has occurred. No faint, no trance, no stupor, how- ever deep, can prevent the manifestation of electric muscular contractility. But ordinarily it is very easy to decide between death and life ; and the fear of being buried alive, which torments many people, is altogether without good foundation. The stories upon which it rests are such as an excited imagination might easily in- vent, and natural fear propagate, but they do not bear critical investigation. In certain European cities, for many years, the bodies of hundreds of thousands of those supposed to be dead have been placed in rooms where ingenious appliances and careful watch- ing have been used to detect the slightest evidence of life, and in not a single case has a mistake been found to have been made. SUPPLIES FOR EMERGENCIES. 107 Supplies for Emergencies. The suggestions in the preceding pages have been, as far as practicable, such as could be carried out without having made any special provision for them. Nevertheless, occasionally appliances and remedies have been suggested, which would very much facili- tate the treatment, if they were accessible. These may be divided into medical and surgical. They may be arranged separately or together, but the former arrangement would probably best suit indi- vidual necessities. SURGICAL CASE. A surgical case suitable for almost any emergency should not contain so many things as to confuse one who has not a medical education. Its supplies should be few and simple, such as — i. Some absorbent cotton. 2. A roll of old muslin or linen. 3. Bandages, 2^ inches wide and 6 yards long, rolled up. 4. Rubber adhesive plaster, on a spool, in a strip 2 inches wide, and not less than a yard long, s. Scissors. 108 ACCIDENTS AND EMERGENCIES. 6. Pins (ordinary and safety pins). 7. Needles, threaded with stout thread. 8. A bottle of hartshorn, with a glass or rubber stopper, 9. A bottle of laudanum, with dose marked on it. 10. A bottle of good whisky or brandy. USE OF THE CONTENTS OF THE SUR- GICAL CASE. 1. Absorbent cotton can be obtained at any drug store. It is perfectly clean and soft, and is prepared in such a way that it — instead of resisting moisture, as ordinary cotton does — will absorb it with great rapidity. Thus it will take up discharges from wounds ; and when a cool or hot application is desired, it can be soaked with cool or hot water. Sometimes it is very convenient to put it on dry and then squeeze the water upon some part of it from a sponge, when every part will rapidly become saturated. For padding splints, or making cushions to prevent pressure of any kind, there is nothing so good as absorbent cotton. 2. Old muslin or linen can be torn into any shape or size that may be required, and can be used to spread poultices upon. It is also useful to make broad slings of. 3. Bandages of the kind described are used to keep applications in place, to secure parts to splints, SUPPLIES FOR EMERGENCIES, 109 and to prevent injurious motion. The simplest way to apply them is to make circular turns around any part. When the latter is of even size this is a very easy matter. Where the part is larger at one end than the other, the ordinary circular turns would not fit smoothly. To accomplish this the rule is to begin at the small end and make a few turns, round and round, one immediately over the other, and then to begin to move up the limb spirally. So long as a Fig. 12. turn can be made to smoothly overlap the one before it about one-third, this spiral is all that is required. But as soon as it puckers the bandage is not carried on as before, but is turned down, so that the inner face now looks out, and the bandage, instead of passing up, passes downwards, so as to make a sort of inverted V — so, a- On now carrying the ban- dage on round the part, it will be found that it comes 110 ACCIDENTS AND EMERGENCIES. to the front, just overlapping the preceding turn, and the same process can be repeated, until the whole bandage is neatly applied. (See Fig. 12.) At joints, like the ankle, knee, and elbow, the bandage may make a sort of figure of 8, the middle or crossing part being in the bend of the joint, and the two loops, one above and one below it. Bandages should never be put on so tight as to cause pain, and never drawn tighter above than below. Bandages may be fastened by pins, by stitching, by strips of adhesive plaster, or by splitting the end and carrying one tail on as before and turning the other back to meet it and then tying the two together. For narrow bandages, the latter is the simplest plan; for wide ones some one of the others is better. The width of 2)4 inches is that which is oftenest convenient. When a narrower bandage is called for — as for a finger — one of the former may be torn down the middle ; or, if rolled up, it can be laid on a firm surface and the whole roller cut in half with a sharp knife, just as one would cut a sausage. This quickly and easily makes two good finger bandages. 4. Rubber adhesive plaster is better than any other kind, because it can be applied without heat or moisture. It sticks of itself. When applied to a hairy part, the hair should be shaved off, if possible. If not, when the plaster comes to be removed, it must be soaked off, or it will pull the hair out and cause great pain. SUPPLIES FOR EMERGENCIES. Ill Another point to be remembered is that, in chang- ing adhesive plaster dressings only so much should be removed as is necessary or as cleanliness demands. The rest may be left on and the new dressing applied up to it or over it. In the end all can be soaked off together. The plaster is most convenient to use when in strips, which can be cut easily and without waste if needed smaller, and additional strips applied side by side, if a greater width is wanted. 5, 6, 7. The use of scissors, pins and needles need not be explained. The points of pins should never be left sticking out, and care should be used to avoid sticking either pins or needles through a patient's skin. 8. Hartshorn is to be used as a stimulant to the heart and to the nervous system. A teaspoonful may be put into a tumblerful of water and a teaspoon- ful of the mixture given every few minutes. Its use by the nose everybody is familiar with. Yet it may be worth while to say that a full bottle of hartshorn should never be brought near to a patient's face. The stopper may be wetted and held under the nose, or a few drops put on a handkerchief, or the hand, and used in the same way. 9. The laudanum bottle should be marked " Poison ! M and have the dose marked on the label. In surgical cases, where there is much pain, a full 112 ACCIDENTS AND EMERGENCIES. dose is called for, and to give less is to trifle with the sufferer. As already remarked, laudanum is one of the very best local applications to wounds and bruises. It can be used by soaking a proper quantity of absorbent cotton, or a piece of old muslin, and laying it upon the injured part. 10. About the whisky, it may be remarked, that a large dose is almost invariably useless or in- jurious. Even for an adult — unless a confirmed drinker — the proper dose is a teaspoonful in a small quantity of hot water — or cold water, if hot cannot be had — repeated every few minutes until some effect is produced, or a couple of ounces — about half a small teacupful — have been given. HOW TO MAKE POULTICES. Poultices. The commonest materials for poul- tices are bread, flaxseed, hops and mush. A hop poultice is made by pouring hot water upon hops till they are well moistened. A bread poultice is made by soaking the inside of bread in hot water or milk, and mashing it quite soft and even. With flaxseed or corn-meal the way is to put the poultice material on a plate, and add just enough hot water to moisten it. This is worked in with a large spoon or table- knife, just as a salad dressing is made. Then to this thick but damp mass, enough hot water is grad- SUPPLIES FOR EMERGENCIES. 113 ually added and worked in until the whole is almost soft enough to run, but not quite. Poultices should be spread thick. To spread a poultice, a piece of fine old muslin (or a piece of open-meshed stuff, such as cheese cloth is made of, can be used), twice as long as the poultice is to be, is laid on a flat surface, and one-half of it spread smooth with the poultice material. The other half is to be brought over and pressed down on top of the poultice material, or another piece of muslin, or a piece of tarlatan can be used for this purpose, so that the poultice material shall not come into immediate contact with the skin ; then, when it comes to be removed, it will come off easily, all at one time, and not leave any behind to stick to the skin. A poultice must be put on hot. To secure this, it may be spread over a hot plate. A simpler plan, however, is to take the finished poultice up by its edges and lay it for a moment or two on something hot, or dip it into a vessel containing boiling water. Care must, however, be taken not to put on a poultice so hot as to burn. To keep a poultice warm when applied, it should be covered with oiled silk or several folds of bandage. It may be remarked that nothing has been said here about the use of " lead water and laudanum M or arnica, so often recommended for bruises and cuts. The reason for this omission lies in the fact 114 ACCIDENTS AND EMERGENCIES. that neither has any merit superior to that of cold water or laudanum alone. When a part is hot and angry, there is nothing better for it than the use of cold water, constantly renewed until the heat and irritation have subsided. When pain is to be com- bated, laudanum alone is the best thing to use locally. MEDICINE CHEST. A small box can be bought, or made, to hold a few things likely to be useful in accidents or sudden sickness. It ought to contain — f Absorbent cotton. Sticking plaster — Rubber plaster (on a spool) is best, because it requires neither heat nor moisture for its application. Bandages of old muslin or flannel. A piece of oiled silk. Thread and needles. Pins (ordinary and safety pins). ^ Cosmoline, Vaseline, or Cold Cream, i. Aromatic spirits of Ammonia. 2. Tincture of Asafcetida. 3. Oil of Cloves. 4. Hoffman's Anodyne. 5. Syrup of Ipecac. 6. Laudanum. 7. Magnesia. 8. Mustard. 9. Paregoric. SUPPLIES FOR EMERGENCIES. 115 10. Spiced Syrup of Rhubarb. ii. Turpentine. To these may be added, if quite convenient : camphor water, essence of ginger, lime water, and sweet spirits of nitre. * Of the eleven first named, a convenient quantity to have would be two fluid ounces ; except of No. 3 (oil of cloves) of which a fluid drachm would be plenty, and No. 7 (the magnesia) and No. 8 (the mustard) of both of which an ounce would suffice. The laudanum and paregoric ought to be in bottles of an altogether different shape from that of those containing the other remedies ; and they, and that of the oil of cloves, should be marked Poison / and have a tape or small ball and chain attached to their necks, so that it could be felt in the dark. Each bottle should have its proper dose plainly printed or marked on the label. DOSES AND USES OF THE MEDI- CINES. 1. Ammonia. The aromatic spirits of ammonia — not hartshorn — is a valuable remedy in cases of sick stomach, and even vomiting. It is also useful in cases of nervous or sick headache, as well as in simple nervousness. The dose is, for an adult, twenty- five drops; for a child, ten drops, in about a wine- glassful of water. This may be given every ten minutes, almost indefinitely. 116 ACCIDENTS AND EMERGENCIES. 2. Asafcetida. The tincture of asafoetida is a nerve tonic, and also very soothing to the bowels. There is nothing better for causing the expulsion of wind. The dose is, for an adult, a teaspoonful ; for a child, twenty drops, in a tablespoonful of water. It can often be used as an injection when it could not be given by the mouth. In this case the quan- tity to be given is a tablespoonful for an adult and a teaspoonful for a child, in a small teacupful of warm water. 3. Cloves. The oil of cloves is useful as a local application in toothache. It is also helpful in indi- gestion, in doses of three drops for an adult, and one drop for a child. It can be given rubbed up with a little sugar, or in a teaspoonful of sweet oil. 4. Hoffman's Anodyne is useful in cases of hysterics and nervous fright or chills. The dose is, for an adult, a teaspoonful in a wineglassful of water. Children rarely require medicines of this sort. But when they do, as is the case with certain high-strung children, half the dose for an adult may be given. 5. Ipecac. The syrup of ipecac is a fairly good emetic. But it must be used freely. An adult should be given a good tablespoonful, and an infant as near a teaspoonful as possible. It will do no harm, and when an emetic is called for, it is no time to run any risk that the dose given may not be large enough. It is often usefully employed in cases of poisoning, convulsions, croup, whooping cough or asthma. SUPPLIES FOR EMERGENCIES. 117 6. Laudanum. Laudanum is the tincture of opium, and has all its properties. It is one of the most useful drugs in the world, and yet it is a danger- ous one. There need, however, be no fear of poi- soning with any preparation of opium if ordinary doses are given, and if these doses are not given closer together than half an hour, and if they are stopped as soon as pain is decidedly lessened or drowsiness comes on. Occasionally, small doses of opium cause great alarm, but there is much less fear about opium poisoning among doctors now than there used to be. It may be considered safe to give twenty-five drops of laudanum to any adult, when there is severe pain, and to repeat this dose every half hour until the pain is lessened or drowsiness begins to appear. One of the signs of the effect of opium on the system is a contraction of the pupil of the eye, which does not expand in the dark. This ought always to lead to a discontinuance of any preparation of opium which has been used. To check diarrhoea, sometimes, a drop of laudanum every hour will prove successful very soon. Yet, ten or fifteen drops may be given to an adult after each movement, if the smaller quantity does not suffice. For cuts and bruises there is no better application than pure laudanum. A soft cloth soaked in lauda- num can be bound on, and occasionally wetted with it, without removal. It quiets pain and promotes 118 ACCIDENTS AND EMERGENCIES. healing. The same application is often very sooth- ing in face-ache, toothache and earache, as well as in the pains of rheumatism and neuralgia. (See " Paregoric") 7. Magnesia. Magnesia is a mild remedy to open the bowels, usually employed for children. The dose being a teaspoonful, given in water or milk. It may also be used for sour stomach, when a pinch will generally be enough. 8. Mustard. In the use of ground mustard for plasters, it should always be mixed with an equal part of flour. Even then it acts quickly and must be removed in a few minutes, as soon as the skin is well reddened. Where it is desired to leave a mus- tard plaster on for more than a few minutes, it should be made of one part mustard to three or more of flour. Every mustard plaster should be removed as soon as the skin becomes red, and not allowed to make a blister, because such blisters are excessively painful and very hard to heal. As an emetic, mustard is used by stirring a tea- spoonful of the ground seeds in a teacupful of luke- warm water. 9. Paregoric. Paregoric is an opium preparation which contains, besides opium and other things, some camphor. It is the best preparation for children, because the dose is easier to measure than that of laudanum. An infant a few hours old will stand three drops, and in a few days, five. In a month, ten SUPPLIES FOR EMERGENCIES. 119 are not too many, and twenty may be given any time after six months. An adult can take a tablespoonful. It may be used internally in all the cases where lauda- num has been recommended. (See " Laudanum.") 10. Rhubarb. The spiced syrup of rhubarb is an excellent mild laxative for the bowels. A teaspoon- ful is the dose for an infant or small child. It is useful at the beginning of a diarrhoea in children, as it empties the bowels of what irritates them, and also has a soothing and healing influence. ii. Turpentine. Spirits, or oil, of turpentine can be used wherever mustard has been recommended as an external application. For this purpose a soft flannel or muslin cloth should be dipped in turpen- tine, wrung out nearly dry, laid on the surface and covered with oiled silk or a few thicknesses of dry cloth, to prevent evaporation. - Red pepper may sometimes be used instead of mustard, though it is more energetic in its action. When moistened and applied to the skin, red pepper first causes a feeling of warmth, and later of intense, fiery burning. If left on long enough it will cause a blister. But this ought never to be done. Red pep- per may be used in cases of colic or cholera morbus, where it quiets pain by its counter-irritant effect, and stimulates the nervous and circulatory systems. In nausea it sometimes does good by the latter process. INDEX PAGE Abdomen, wounds of. 55 Accidents, railroad and machinery 63 Acids, as antidotes 95 burns with 38 poisoning by 86 Aconite, poisoning by 92 Alcohol, poisoning by 92 as a stimulant 67 Alkalies, as antidotes , 95 as poisons 88 burns with 38 Ammonia, as an antidote 95 as a medicine 115 as a poison 88 as a stimulant 111 Antidotes, to prepare 95 (See various poisons.) Apoplexy 32 Arsenic, poisoning by 88 Arteries, wounds of. 73 in arm 74, 76 in foot 77 in forearm 75 in hand 75 in leg 77 in scalp 78 in thigh 77 Asafoetida 116 Asthmatic attacks 100 Back, broken 52 Bandaging 108 Bites, of cats 60 of dogs 60 of rats 60 of serpents 59 Black-drop, poisoning by 90 Bland fluids 95 Bleeding. (See Hemorrhage.) .... Blood vessels, location of. 69 Bones, broken. (See Fracture.) Brain, disorder of. 25 injuries of 35 Bruises 54 Bugs, in ear 23 Burns 36 Capillaries 71 121 PAGE Carbolic acid, poisoning by 87 Carron oil 37 Catalepsy, 34 Cat bite , 60 Caustic, burns with 3! poisoning by 89 Chloral 91 Choking 17 Cholera morbus 96 Circulation, description of. 69 disturbance of. 25 Cleansing wounds 56 Cold and heat, effects o£ 41 Colic 97 Collapse. (See Shock.) Collar bone, fracture of. 51 Contusions 54 Convulsions 32 Corrosive sublimate, poisoning by. 89 Cramps 96,97 Croup 99 Crush 6$ Cuts. (See Wounds, incised.) Cut throat 56 Death, signs of. 104 Decayed meats or vegetables 93 Depression. (See Shock.) Diarrhoea 98 Dislocations..- 45 Dog bites 60 Drowning 12 Drunkenness. (See Intoxication.) Ear, foreign bodies in 93 Earache io« Emergencies, domestic 96 Emetics 94 Epilepsy 30 Eye, black 54 lime in 2s splinters in 5* Fainting 29 Fishhooks 57 Fits 24, 30 32 Fluids, bland 95 Foreign bodies, in ear 23 122 INDEX. PAGE Foreign bodies, in eye 20 in mouth 18 in nose 22 in throat 17 in windpipe 17 Fractures 48 compound 52 Freezing 41 Gases, noxious 16 Glass, splinters of. 58 Gunshot wounds 61 Hanging 16 Hartshorn. (See Ammonia.) Heat, effects of. 36 exhaustion 39 stroke 38 Hemlock, poisoning by 92 Hemorrhage 69 capillary 72 from arteries 73 from veins 73 from bowels 81 from lungs 80 from nose 80 from stomach 80 internal 81 Hooks, fish 57 Hydrophobia 61 Hysterics 30 Insects, in ear 23 stings of. 59 Insensibility 24 Intoxication.. 26, 33 Iodine, poisoning by 90 Jamestown weed, poisoning by 92 Jaw, dislocation of. 45 fracture of. 52 Joints, injuries of. 45 Laudanum 117 poisoning by 90 Lead, sugar of, poisoning by 89 Lightning stroke 40 Lime, in eye, 22 Liniments containing poison 88 Liquids, bland 95 Litters for injured persons 82 Lungs, hemorrhage from 80 Lye, burns with 38 poisoning by 88 PAGE Machinery accidents 63 Meats, decayed, poisoning by 93 Medicine chest 114 use of. 115 Monkshood, poisoning by 92 Morphine, poisoning by 90 Muriatic acid 86 Mustard 118 Nausea 97 Needles, wounds with 57 Nervous attacks 101 Nightshade, poisoning by 92 Nitric acid 86 poisoning by 86 Nose, bleeding from 80 foreign bodies in..i 22 Oil of vitriol. (See Sulphuric Acid.) Opium, poisoning by 90 Oxalic acid, poisoning by 87 Paregoric, as a medicine 118 poisoning by 90 Paris green 89 Phosphorus 89 Pin wounds 57 Poisons 85 table for treatment 93 Poison vine 102 Potash, poisoning by 88 Poultices 112 Railroad accident injuries 63 Rat bites 60 Respiration, artificial 12 obstructions to 12 Resuscitation, from drowning 12 from opium stupor... 91 Scalds 36 Shock 66 Silver, nitrate of. (See Caustic,lunar.) Skull, fracture of 52 Snake bites 59 Soda, poisoning by 88 Spanish-windlass 76 Spinal column, fracture of. 52 Spitting blood. (See Hemorrhage from Lungs.) Splinters 58 Splints 53 Sprains 43 Stimulants 15, 86, 95, in, 112 INDEX. 123 PAGE Stimulation 15, 67 Stings of centipedes 59 scorpions 59 serpents 59 tarantulas 59 insects 59 Stomach, hemorrhage from 80 Strangling. (Strangulation) 16 Stunning 35 Strychnine, poisoning by 92 Sublimate, corrosive, poisoning by. 89 Suffocation 16 Sugar of lead, poisoning by 89 Sulphuric acid, poisoning by 86 Sunburn 38 Sunstroke 38 Supplies for emergencies 107 Surgical case 107 use of. 108 Tartar emetic, poisoning by 89 Thorns 58 Toadstools, poisoning by 93 Tobacco, poisoning by 92 PAGE Toothache 101 Transportation of the injured 82 Unconsciousness 24 doubtful cases 26 treatment of 29 Vegetables, decayed, poisoning by 93 Veins, wounds of. 73 Vitriol, oil of. 86 Vomiting, to allay 86, 97 to produce 94 Washing wounds 56 Whooping cough 100 Windlass, Spanish 76 Wounds 54 cleansing of. 56 contused 55 gunshot 61 incised 55 lacerated 56 poisoned 59 punctured... 57 THE AMERICAN HEALTH PRIMERS. EDITED BY W. W. KEEN, M. D., Fellow of the College of Physicians of Philadelphia, 12 Volumes. 32mo. Cloth Binding, 50c. May be Ordered through any Bookseller. This Series of Health Primers is prepared to diffuse as widely and cheaply as possible, among all classes, a knowledge of the elementary facts of Preventive Medicine. They are intended incidentally to assist in curing diseases, and to teach people how to form correct habits of living and take care of themselves, their children, employees, etc. They are written in a plain, untechnical style, by well-known professional gentlemen, with especial reference to our Climate, Sanitary Legislation and Modes of Life. I. HEARING AND HOW TO KEEP IT. With Illustrations. By Chas. H. Burnett, m.d., of Philadelphia, Aurist to the Presbyterian Hospital. With Illustrations. Contents. — The Structure of the Ear ; The Physics and Physiology of Sound and Hearing ; Diseases and Injuries of the Ear, including Deaf- Dumbness and the avoidance of improper treatment ; The Care of the Ear in Health and Disease; The Relief of Deafness, and the Education of Deaf Children. II. LONG LIFE AND HOW TO REACH IT. By J. G. Rich- ardson, m.d., of Philadelphia, Professor of Hygiene in the University of Pennsylvania. Contents. — Introductory Considerations, Causes of Disease and How to Avoid Them ; Heat and Cold as Causes of Disease ; Contagious Diseases and How to Escape Them ; Rules regarding Proper Clothing ; Pure Air ; Ventilation; etc., and the Fatal Effects of Impure Air; Pure Water and the means of obtaining it ; and where not to get it ; Baths, their Value and Evils; Houses, Drains, etc.; Food and Digestion ; Modes of Cooking, etc.; Impure and Adulterated Food and Drink, and the means to Detect Them ; Exercise, and How and When to take it ; Sleep, Deficiency of. Means of Promoting, etc.; The Mind ; Brain Diseases ; Intellectual Labor, etc ; The Trichinae or Pork Worm ; Insects, Ringworm, etc.; Old Age, and the best way to meet it. III. THE SUMMER AND ITS DISEASES. By James C.Wilson, m.d., of Philadelphia, Lecturer on Physical Diagnosis in Jefferson Medical College. Contents. — The Summer; Sunstroke and Heat Fever; Summer Diar- rhoea and Dysentery ; Cholera-Infantum and Children's Diseases ; Summer and Autumnal Fevers ; Summer Colds and Hay Asthma ; The Skin in Summer and its Diseases, etc. THE AMERCAN HEALTH PRIMERS— (Continued). IV. EYESIGHT AND HOW TO CARE FOR IT. With Illustra- tions. By George C. Harlan, m.d., of Philadelphia, Surgeon to the Wills (Eye) Hospital. Contents. — Introduction ; The Anatomy and Physiology of the Eye ; The Ophthalmoscope ; Injuries and Diseases of the Eye ; Optical Defects ; Spectacles ; Practical Hints for the Care of the Eyes ; Effects of School Life upon the Eyesight, etc. V. THE THROAT AND THE VOICE. With Illustrations. By J. Solis Cohen, m.d., of Philadelphia, Lecturer on Diseases of the Throat in Jefferson Medical College, and on the Voice in the National School of Oratory. Contents. — Part I. — Construction of the Throat ; Sore Throats; Diph- theria ; Croup ; Enlarged Tonsils ; Laryngitis ; Foreign Bodies and Morbid Growths; Paralysis; Spasm; Neuralgia of the Throat ; Catarrhs, etc. Part II. — The Voice; Acoustics; The Vocal Organ; Vocal Culture; Improper Use of the Voice ; Vocal Gymnastics ; Defects of and Care of the Voice. VI. THE WINTER AND ITS DANGERS. By Hamilton Osgood, m.d., of Boston, Editorial Staff, Boston Medical and Surgical Journal. Contents. — General Considerations; Dangers from Errors in Dress; Carelessness and Ignorance in Bathing ; Inattention to Pulmonary Food ; Danger from Overheated Air and Poor Ventilation ; Indifference to Sun- shine ; Sedentary Life and Neglect of Exercise ; Dangers of School Life ; Winter Amusements; Closing Suggestions, etc. VII. THE MOUTH AND THE TEETH. With Illustrations. By J. W. White, m.d., d.d.s., of Philadelphia, Editor of the Dental Cosmos. Contents. — The Mouth; Anatomy and Development of the Teeth; Temporary Teeth ; Difficult Dentition ; Permanent Teeth ; Nutrition of the Teeth ; Food in its Relations to the Teeth ; Nervous Relations ; Constitu- tional Peculiarities ; Varieties, Defects and Irregularities of the Teeth ; Tartar ; Salivary Calculus ; Decay ; Caries ; Toothache ; Extraction ; Hemorrhage ; Hygiene of the Mouth ; Reparative Treatment ; Substitu- tion ; Artificial Teeth, etc. VIII. BRAINWORK AND OVERWORK. By H. C. Wood, Jr., m.d., of Philadelphia, Clinical Professor of Nervous Diseases in the University of Pennsylvania. Member of the National Academy of Science. Contents. — Nervous Diseases Increasing; General Causes of Nervous Trouble; Excesses; Exposure, etc.; Effects of Emotional and Intellectual Work; Unnecessary Work ; Women's Work, etc.; Rest and Recreation; Exercise ; Vacations ; Camping Out ; Sleep ; Stimulants During Labor ; Signs of Nervous Breakdown. IX. OUR HOMES. With Illustrations. By Henry Hartshorns, m.d., of Philadelphia, formerly Professor of Hygiene in the University of Pennsylvania. Contents. — Introduction ; Situation ; Construction ; Light ; Warmth ; Ventilation ; Water Supply ; Drainage ; Disinfection ; Population ; Work- ingmen's Homes. THE AMERICAN HEALTH PRIMERS— (Continued). X. THE SKIN IN HEALTH AND DISEASE. With Illustra- tions. By L. D. Bulkley, m.d., of New York, Physician to the Skin Department of the Demilt Dispensary and of the New York Hospital. Contents. — Anatomy and Physiology of the Skin ; The Care of the Skin in Health ; Diseases of the Skin; Parasites, etc.; Diet and Hygiene in Diseases of the Skin. XI. SEA AIR AND SEA BATHING. With Illustrations. By John H. Packard, m.d., of Philadelphia, Surgeon to the Episcopal Hospital. Contents. — Introduction; Different Seaside Resorts ; Mud, Sand, Turk- ish and other Baths; Sea Bathing; How to Float and Swim; Accidents; How to Treat the Apparently Drowned ; Effects of Sea Bathing for In- valids ; Cottage Life and Amusements at the Seashore ; Sanitary Matters ; The Seashore as a Winter Resort; Excursions to the Seashore. XII. SCHOOL AND INDUSTRIAL HYGIENE. By D. F. Lin- coln, m.d., of Boston, Mass., Chairman Department of Health, Ameri- can Social Science Association. Contents. — Part I. — School Hygiene ; General Remarks ; Mental and Emotional Strain of Scholars ; Amount of Study ; Growth and Exercise ; Care of the Eyes ; School Desks and Seats ; A Model School Room ; Ventilation and Heating; Situation; Drainage, etc.; Private Schools; Colleges ; Contagious Diseases. 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A little too much food, or food of a bad kind, or food badly cooked, or eaten at the wrong time or too quickly, a glass of bad wine, bad milk or water, to say nothing of the disturbances occasioned by changes of atmo- sphere, and a hundred other causes, bring about such normal changes in the body as to make even the strongest and healthiest among us to feel for a time unwell ; almost every one, in fact, experiences such departures from the healthy condition. It is about these slight ailments, which cause so much discomfort, and often a great deal of pain, that Dr. Beale treats. The old adage, that " prevention is better than cure," applies pertinently to slight ailments, as it is these which are often the forerunners of disease and doctors' bills. 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