LIBRARY OF CONGRESS. fl&t ?°f2_ UNITED STATES OF AMERICA. ACCIDENTS EMERGENCIES DULLES. Showing the Course of the Principal Blood Vessels. ACCIDENTS AND EMERGENCIES A MANUAL OF THE TREATMENT OF SURGICAL AND MEDICAL EMER- GENCIES IN THE ABSENCE OF A PHYSICIAN. i CHARLES W^DULLES, M.D., FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA AND OF THE ACADEMY OF SURGERY; PHYSICIAN TO THE RUSH HOSPITAL; FORMERLY SURGEON TO THE OUT-DOOR DEPARTMENT OF THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA AND OF THE PRESBYTERIAN HOSPITAL, IN PHILADELPHIA, AND ASS'T SURGEON SECOND REGIMENT, N. G. PA. FOURTH EDITION, THOROUGHLY REVISED AND ENLARGED. Witft Nrfo Illustrations. PHILADELPHIA: P. BLAKISTON, SON & CO. No. 1012 Walnut Street. 1892. ^S£P 28 1892 UiFWASHIIt§522> Copyright, 1892, by P. Blakiston, Son & Co., Philadelphia. Press of Wm F. Fell &. Co., 1220-24 Sansom St., philadelphia. Preface to First Edition. Whoever has seen how invaluable, in the presence of an 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. Extract from Preface to Second Edition. 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 over, 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. vn Preface to Fourth Edition. The call for a fourth edition of this little book has afforded an opportunity for a very thorough revision of it and the addition of much new matter and of new illustrations, which, it is hoped, will enhance its usefulness. In sending it out, the author invites its readers to favor him with any suggestions which may be used to make the book, in later editions, better fitted for the work it is intended to do. 4101 Walnut Street, Philadelphia, August, 1892. Vlll Table of Contents. PAGE Preface v Preliminary Remarks 9-1 1 Obstructions to Respiration 12-20 Drowning 12 Strangulation 16 Suffocation with gases 17 Choking 17 Foreign Bodies in the Eye, Nose and Ear . . 21-25 Foreign Bodies in the Eye 21 Foreign Bodies in the Nose 23 Foreign Bodies in the Ear 24 Unconsciousness or Insensibility ....... 26-32 Disorder of Circulation 27 Disorder of Brain 27 Poison . . . . 28 Intoxication 28 Fits or Seizures 33~39 Fainting 33 Hysterics 34 Epileptic Fits 35 Convulsions in Children 36 Apoplexy 37 Intoxication ^8 Catalepsy 38 Sunstroke, 39 ix X TABLE OF CONTENTS. PAGE Injuries to the Brain 40 Concussion of the Brain 40 Compression of the Brain 40 Effects of Heat 41-46 Burns or Scalds 41 Sunburn 44 Sunstroke, or Heatstroke 44 Heat Exhaustion 45 Lightning Stroke 46 Effects of Cold 47-48 Frost-bite 47 Freezing 47 Sprains 49-50 Dislocations 51-53 Fractures 54-60 Wounds 61-71 Contusions 61 Contused Wounds 62 Incised Wounds 62 Lacerated Wounds 64 Punctured Wounds 65 Splinters 66 Poisoned Wounds 68 Bites of Serpents , 68 Stings 68 Bites of Dogs 69 Gunshot Wounds 71 Railroad and Machinery Accidents 72—77 Lacerations . 73 Crushes 74 Shock 75 Hemorrhage — Bleeding 78-90 Special Hemorrhages 91-92 Transportation of Injured Persons 93 TABLE OF CONTENTS. XI PAGE Poisons 97~ io 9 Description of Poisonous Plants 110-118 Domestic Emergencies 1 19-129 Cholera Morbus • .... 1 19 Colic 120 Vomiting, or Nausea . 120 Diarrhoea 121 Dysentery 122 Croup 123 Whooping Cough 124 Asthmatic Attacks 125 Nervous Attacks 125 Toothache 126 Earache 126 Poisoning with Poison Vine 127 Neuralgia of Face 127 Convulsions 128 Fever 128 Supplies for Emergencies 130 Emergency Case 130 Use of Emergency Case • . . . 133 Bandaging 134 Doses of Medicines 137-144 How to Make Poultices . . . 144 Signs of Death 146-148 ACCIDENTS 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 a 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 persons, and no more than are needed, should be called on to assist in removing the one in trouble, 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 investiga- r 9 10 ACCIDENTS AND EMERGENCIES. tion may be made to find out, as nearly as possible what is wrong, so that an intelligent line of subse- quent action may be 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 or other means of transportation provided. Hot or cold applications may be needed, and should be made 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 instructions 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 physician and to the 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. Treatment. — 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, thrust- ing a finger into the mouth and sweeping it round, to bring away anything that may have got in or accumulated 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 OBSTRUCTIONS TO RESPIRATION. 13 to cause the neck to be stretched out and the chin to be carried far from the chest. The tongue should now be drawn well forward out of the mouth and held by an assistant, if there be one present. A very good way to get the base of the tongue clear of the windpipe is to press the angles of the jaw forward with both thumbs applied to them just in front of the lobes of the ears. An effort to secure artificial respiration should now be made. The simplest way to do this is for some one to place him- self on his knees behind the head, seize both arms near the elbows and sweep them round horizon- tally, away from the body Fig. i. 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 inspira- tion — fills the lungs with air, — by drawing the chest- wall 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, 14 ACCIDENTS AND EMERGENCIES. 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 minute. It should Fig. 2. be kept up for a long time, and not abandoned until a competent person has ascertained that the heart has ceased to beat. The cessation 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 practised 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 pulsation in the aorta, the main artery of the body, when it cannot be found anywhere else. It is important that wet clothing shall be removed as soon as possible from a drowned person. 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 OBSTRUCTIONS TO RESPIRATION. 15 may be loosened under it and drawn down over the feet. Then the body may be quickly slipped on to something 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 sum- mer 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 in- terfere 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 tablespoon ful 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 respiration better than that of a good Faradic battery, used so as to bring about reflex sobbing, or deep breathing, by the pain it causes. Little by little natural breathing will take the place of the 16 ACCIDENTS AND EMERGENCIES. artificial, but it 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 nat- ural respiration is failing. Strangulation, by hanging, or by any con- striction of 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.* *The Philadelphia Press, Sept. 19, 1884, published a report from Pittsburgh that a man had been found hanging by a clothesline in an outhouse of the Crescent Steel Works the day before. He was discovered by the watchman, who ran and called a helper; but neither. would cut the man down until a physician had pronounced him dead, seeming to have a confused idea that as this is the custom at a public hanging, it ought to be observed at a pri- vate one also. OBSTRUCTIONS TO RESPIRATION. 17 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 speaking of Drowning (page 13). Gases like car- bonic acid, illuminating gas, the fumes of charcoal, and the collections in mines, wells, or privies, are very dangerous 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 low- ered, 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 somewhat protected by wearing a sack over his head, or having a thick vail or a few folds of a handker- chief over his mouth and nose. But everything will depend upon the rapidity with which he and his comrades can do their work. Choking is caused by something sticking in the throat, gullet, or windpipe. 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 swallow- 18 ACCIDENTS AND EMERGENCIES. ing 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. About the throat, it is not so hard to tell, for one can usually see or feel with the finger the offend- ing body. Treatment. — 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 in trying to dislodge the foreign body ; or the handle of one blade of a pair of scissors may be used in the same way ; or two small spoon handles may be used like tongs to draw it out. 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 forci- bly into the ear. This sometimes excites power- ful 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 OBSTRUCTIONS TO RESPIRATION. 19 things. The responsibility of attempts to poke them down may well be left to a surgeon. If pins, or needles, or fish bones get stuck in the mouth or throat, it is sometimes an extremely delicate matter to remove them. Sometimes, on the other hand, they may be grasped with the fingers or a pair of blunt-pointed-scissors — used like forceps — and pulled out. If this cannot be done, the patient should be made to lie down, and kept as quiet as possible in body and mind, until 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 in which 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 that 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 20 ACCIDENTS AND EMERGENCIES. adults), it is a mistake to give a purgative. The proper plan is to let the bowels alone and to give for a day or two plenty of good, solid food, espec- ially vegetables, like potatoes or corn-meal mush, so that the foreign body may be surrounded with the waste and carried out of the body without injuring the walls of the intestines. FOREIGN BODIES IN EYE, NOSE, AND EAR. 21 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 lid, 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 eyeball. At the same moment the end of the second finger is pressed against the skin of the lid above its edge. The patient is now told 22 ACCIDENTS AND EMERGENCIES. 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, to take a slender pencil, or a knitting or crochet needle, and place it against the eyelid, parallel to FlG - 3 - and one-third of an inch above the edge, and then to pull the edge up and turn it back 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 removed. A magnifying glass is sometimes needed to see frag- ments 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, FOREIGN BODIES IN EYE, NOSE, AND EAR. 23 poured freely in the eye. Or, a little laudanum may be poured into a heated cup, and when evaporated to a kind of jelly it can be thinned out with clear water and then poured into the eye. A bandage, loosely applied, so as to shut out light and keep the eyeball rather quiet, often does much good. If removal of a foreign body proves difficult or impossible, it is usually very soothing to put a drop or two of olive oil or castor oil into the eye. 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 some- times 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, it is best to abstain from efforts to fish it out, for such efforts may do much damage, while the presence of a foreign body in the nose is ordinarily neither dangerous nor very annoying. When simple efforts to remove a foreign body from the nose are unsuccessful a surgeon must be called, and the sooner it is done the better. The 24 ACCIDENTS AND EMERGENCIES. 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 fact that if they absorb any moisture they swell up, and may be very difficult to get away. Foreign Bodies in the Ear. The removal of foreign bodies from the ear is sometimes very diffi- cult, 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 and unusual skill. Yet, if no medical man be attainable at all, and if it be remem- bered that the outer passage of the ear is only 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 with warm water. In doing this, the ear should be gently pulled upward and backward, the point of the syringe being placed in the upper part of the external canal, so that the stream of water can get behind the object and sweep it out. The person's head must be held with the face down, as in this position gravity lends some assistance. Exceedingly gentle efforts may even be made to remove a foreign body with a crochet needle, or a hairpin, or an ear spoon, if it can be had. But with all these it must be remembered that irreparable damage may be done by the least rough- ness or the least slip. The syringe should not be FOREIGN BODIES IN EYE, NOSE, AND EAR. 25 used if the foreign body is a pea or bean ; for water will make either of these swell up and become much harder to remove. It should be remembered, also, that there is generally no danger in letting alone a foreign body in the ear. Most foreign bodies are far less dangerous than the efforts made to remove them. If live insects get into the ear, oil or glycerine or salt and water (a teaspoonful to a half pint) should be poured in. After about half an hour the ear may be syringed in the manner already described. 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. 26 ACCIDENTS AND EMERGENCIES. Unconsciousness or Insensibility. Unconsciousness, or Insensibility, occurs in many different conditions, and it is of great importance that something should be known about them by railway officials and railway servants, manu- facturers, superintendents of mines and public works, surveyors, constructors, keepers of hotels, and schoolmasters 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 drunk- enness. This, it must be acknowledged, is often hard to do. But so much the more reason is there for attempting to learn enough to prevent such shameful mistakes as are sometimes made. So, before speaking 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 cause of unconscious- ness may be classified as : disorders of the circula- UNCONSCIOUSNESS OR INSENSIBILITY. 27 tion, disorders of the brain, poisoning, and intoxi- cation. Unconsciousness due to Disorder of the Circulation, or temporary failure of the heart, is familiarly 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 condition is easily recognized by itself or from its cause. The loss of consciousness is accompanied by paleness of the lips and face, and usually by cold- ness of the extremities, with more or less appearance of perspiration. Unconsciousness due to Disorder of the Brain may depend upon disease or injury. Disease of the brain is recognizable by its gradual approach, which can be learned from the sufferer's friends, and is not likely to prove more perplexing than is faint- ing. On the other hand, injuries 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 circum- stances which make a suspicion of violence reason- able. In apoplexies some of the external evidences might prove misleading, but besides these there is often found an unequal enlargement 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, 28 ACCIDENTS AND EMERGENCIES. and the peculiar cry before unconsciousness sets in, with which every one is familiar. Unconsciousness due to Poison may be caused by a poison generated within the body, an ex- ample of which sometimes occurs in serious kidney disease. In such cases there are usually convulsions or twitching of the muscles, and often a dropsical appearance about the eyes and legs, with delirium or profound stupor, and a smell like that of stale urine about the person affected. The cause of poisoning by gases is generally easy to detect by the aid of surrounding circumstances. The only insensibility due to drugs which is actu- ally 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 oppo- site to what is seen in drunkenness. Unconsciousness due to Intoxication is marked, it is true, by many signs of other insensi- bilities ; but it has these peculiarities : usually the face is flushed and the body relaxed everywhere ; the person may be roused by loud cries ; the pupils are dilated evenly, and a distinct odor of liquor may be discovered. When a doubtful case arises, the first thing to be done is to see if the odor of liquor can be detected. If not, one may be quite sure he is not dealing with a case of intoxication. But if, on the other hand, the odor is present, one must not conclude at once that UNCONSCIOUSNESS OR INSENSIBILITY. 29 the case is one of simple drunkenness. For it often happens that liquor is given after an accident \ and an accident may have happened to a man who had been drinking. To avoid mistake : — i. The head ?nust be examined. If there is a cut or a bruise, it is prudent to assume 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, the case is probably one of brain disease or opium poisoning. If one pupil is contracted and the other is dilated, it is a case of injury or disease of the brain. 3. The face must be examified. If it is drawn and wrinkled on one side, and smooth on the other, the case is probably 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, the patient's condition is probably due to epilepsy or some other convulsive disorder — not simply to intoxication. Of course, it must 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 exa7nined. If one is stiff and one limber, or if one moves when pinched and the other does not, the patient has one-sided 30 ACCIDENTS AND EMERGENCIES. paralysis, or hysterics. If the latter, the person affected will usually resist any attempt that may be made to open the eyelids ; and when the eyelids are forcibly opened the eyeballs will usually be found persistently 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 shin must be investi- gated. If the skin be burning hot and dry, sunstroke or heatstroke may be suspected, if the time of year or the occupation of the patient warrant such a con- clusion. After all these tests have been applied, there will still be a few cases in which 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 intoxi- cation, too — though it be at the risk of being some- times deceived and imposed upon. This is of especial importance in the case of persons under arrest ; for such persons have lost their lives because it was taken for granted that they were only " drunk," while in fact they were ill or injured — with or with- out being drunk also. When there is any doubt the UNCONSCIOUSNESS OR INSENSIBILITY. 31 person should be transported and treated with great care, an attempt being made to discover what disease or injury, alone or combined with intoxication, has produced the condition 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, until they can rest the responsibility of his fate on others better instructed or in authority over them. Treatment. — The treatment suitable for all cases in which there is doubt as to the cause of un- consciousness 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 under the nose, and hot tea or coffee may be given, while heat is 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. One precaution must always be taken in giving fluids to more or less un- conscious persons, namely, to see that the fluids are swallowed and not taken into the lungs. Even in general unconsciousness, swallowing is usually ef- fected as soon as a fluid reaches the back of the tongue ; but fluids have entered the windpipe when given by the mouth. If such an accident should occur, it would at once produce violent coughing; 32 ACCIDENTS AND EMERGENCIES. and this would give warning to stop the administra- tion of the liquid. 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 different cases should be managed. FITS OR SEIZURES. 33 Fits or Seizures. Fainting is too familiar to need much detail of its 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 the skin in fainting is very well known, and is simply a signal of the like bloodlessness which obtains in the brain itself. Treatment, — Usually no treatment is demanded in fainting; 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 pre- vented from happening of itself, it should be brought about 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 sending blood to the brain ; and heavy wraps, tight collars, corsets, or waist bands should be loosened or removed. Sprinkling water upon the face and hold- ing smelling salts or spirits of camphor to the nose, 34 ACCIDENTS AND EMERGENCIES. tend to excite the nerves of sensation and rouse the brain and heart to renewed activity. In using strong salts or hartshorn, care must be taken not to scald the nose of the patient by holding either too close or using it too long. Simple and gentle stimulation is usually sufficient to bring a person out of a faint ; and if one should be very slow in coming to, it might 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. After a fainting fit, from fifteen drops to half a teaspoon ful of aromatic spirits of ammonia, or a small quantity of an alco- holic stimulant (wine or whisky) may occasionally — though very rarely — be useful. The latter is best given with a moderate quantity of hot water. 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 by- standers, 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 gener- ally recommended. Good is sometimes done by giving teaspoonful doses of valerian or Hoffman's anodyne, if it can be obtained. FITS OR SEIZURES. 35 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 pallor or lividity of the face, a peculiar cry, loss of consciousness, a moment of rigidity, and then the face becomes con- gested and more or less 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. Treatment. — Epileptic fits are to treated very much like fainting fits, because in them also the brain is tem- porarily bloodless. At the same time any movements calculated to injure the person must be controlled. There is no use in struggling against such movements as will do no injury; they had better be simply regulated, and no attempt need be 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. In doing this the helper must look out for his own fingers, lest they be bitten. When the height of the con- vulsion is passed, rest, quiet, and, perhaps, mod- erate stimulation may be secured. Here, again, as in fainting, the flat position of the body must be obtained, and very moderate stimulation may occa- sionally be useful after consciousness is restored. 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 36 ACCIDENTS AND EMERGENCIES. 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 entire 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 sewed just inside the coat, or in some place 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 fretful- ness. When they come on, there is a loss of con- sciousness 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. Treatment. — When convulsions occur, the child should have cold applied to the head and heat to the FITS OR SEIZURES. 37 body. It often does good to place it into a tub of hot water to which some mustard has been added. A large injection of hot soapsuds 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. This should be followed by a dose of castor oil. Apoplexy consists in the rupture of a blood vessel in the brain, and is marked by a slow pulse, more or less sudden loss of consciousness, stupor, heavy snoring breathing, in which one cheek is some- times puffed out with each outgoing breath, and usually a deeply flushed face. The pupils are gen- erally dilated. Paralysis may be observed at once, or it may appear after some time. Usually it is limited to one side, and may be detected by observ- ing 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 flabby side is para- lyzed, not the drawn one, as is sometimes supposed. Treatment. — For this condition, rest and cold to the head constitute 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, like castor oil or Epsom or Rochelle salts, should be given by the mouth as soon as it can be swallowed. 38 ACCIDENTS AND EMERGENCIES. 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 should never be forgotten that the odor of liquor 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 drunken- ness there is no paralysis, though there is helpless- ness equally on both sides, that the person can be aroused from the stupor, and that generally if the eyeball be touched with the finger he will attempt to close the eyelids. Treatment, — In a case of profound intoxication an emetic should be given, and, if any hartshorn or aromatic spirits of ammonia is at hand, a teaspoon- ful 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 pro- found 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 FITS OR SEIZURES. 39 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. Sunstroke produces a form of unconsciousness which will be considered under the head of " Effects of Heat." 40 ACCIDENTS AND EMERGENCIES. 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. Treatment. — The proper treatment for this con- dition is to lay the sufferer out flat on the back, to loosen any clothing that binds his neck or waist, and to 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 by 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 that for apoplexy. (See p. 37.) EFFECTS OF HEAT. 41 Effects of Heat Burns or Scalds are usually dangerous in pro- portion to their extent, rather than to their depth. Those which involve as much as half the surface of the skin are almost necessarily fatal. The treatment of burns may be considered 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, — any woolen thing (not cotton or linen, for these take fire too easily), which will exclude the air and smother the flame. It is especially important to keep flames from the face, if possible. 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 envelop- ing 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 (using sharp scissors,) 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 D 42 ACCIDENTS AND EMERGENCIES. elevated cuticle, or outer skin, to fall down upon the deeper layer. Then a dressing of pure sweet oil, or castor oil, or any oily substance free from salt, like liquid vaseline or new-washed lard, should be applied on strips of soft old linen, and disturbed as 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, kept at a temperature of ioo°. When the shock of a burn is great, moderate quantities of some stimulant should be given, and laudanum, in twenty-drop doses to an adult, and half as much to a child, may be used to allay suffering. The amount of pain in very extensive burns is much less than is generally supposed. Those who see many cases of severe burns know that there is usually not much pain in fatal cases; in fact, the absence of pain sometimes leads the friends to indulge in false hopes of the patient's recovery. Slight Burns or Scalds are best treated by applying a cloth soaked in a solution of baking soda * To make lime-water, put a piece of unslacked lime the size of a very large walnut into a common-sized bottle containing a pint or two of cold water, shake it up a few times, then let it settle. One need not fear making it too strong; the water will take up only a certain quantity of the lime, however much is put into it. EFFECTS OF HEAT. 43 (the bicarbonate) in the proportion of a heaping tablespoon ful in a teacupful of water ; or the soda may be powdered on without using any water. This usually allays the pain more effectually than any- thing 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 soapy water, or white lead paint. A good applica- tion for burns may be made of strips of linen or muslin soaked in a mixture of a teaspoonful of car- bolic acid, two tablespoon fuls of glycerine, and a pint of olive-oil, or in carbolized vaseline, obtained at a drug store. 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. 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.* *For the treatment of cases in which acids or alkalies are taken into the mouth or swallowed, see under " Poisons.'* 44 ACCIDENTS AND EMERGENCIES. Burns with Hot Pitch. After such burns the pitch often sticks. In such a case it ought not to be removed, but let alone until it is coming off of itself. Sunburn, and the burns caused by external appli- cations, like mustard or Spanish flies, may be treated very successfully with baking soda. This may also be mixed with vaseline, or cosmoline, or lard from which the salt has been boiled out, and the mix- ture 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, especially in con- fined 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, how- ever, culminates in a loss of consciousness, with heavy, labored breathing, and an intense, burning, dry heat of the skin, while the bladder and 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. Treatment. — The treatment of heatstroke consists in lowering the temperature. As much of the cloth- ing as possible must be removed, and the patient must be transported to a cool and airy place, if pos- sible. Cold must then be applied to the head and EFFECTS OF HEAT. 45 body in the form of cold water or ice 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, to be 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 con- founded with sunstroke or heatstroke. But in heat exhaustion, instead of a hot, dry skin, there is a cold, moist one. Treatment. — Heat exhaustion must be treated with rest and fresh air, in a cool apartment \ but there must be no application of cold to the surface. Small doses of brandy, thoroughly diluted, may be given, so that the system may be gradually brought back from its depression. 46 ACCIDENTS AND EMERGENCIES. Lightning Stroke is marked by evidences of shock, with reduction of the force of the circulation, weak pulse, and slow, sighing breathing. Its entire treatment consists in moderate rest and stimulation, with warmth applied to the body. Nothing else can be done for the sufferer. EFFECTS OF COLD. 47 Effects of Cold. Frost-bite 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 in this part of the world, partly because of the practice of wearing tight and in- sufficient coverings on the feet. Frozen fingers, ears, or noses are of less frequent occurrence, but they are common enough in colder climates. Treatment. — All forms of frost-bite or local freez- ing are to be treated in the same way, which consists in gradually bringing the temperature up to the normal point (about 99 Fahrenheit) and maintain- ing it there. For this purpose moderate friction may be used, or soaking in moderately hot water or with hot, wet cloths. Rubbing with snow is used in cer- tain countries where snow is plenty and the custom is well established ; but warmth is what is needed, and there is no virtue in the cold of the snow — the rubbing does the good. The practice of soaking frosted feet in ice water will soon be abandoned by any one who gives a fair trial to warm water. Freezing. If the whole body has been long ex- posed to extreme cold, there will follow a depression 48 ACCIDENTS AND EMERGENCIES. of vitality which requires the most cautious treat- ment. To restore the sufferer, restoration of his bodily warmth is indispensable. This may be effected by immersing him in a warm bath, which should be made gradually warmer until it is as hot as can be well borne. Surrounding the patient with heated blankets, or exposure before an open fire may be used if the bath is not conveniently obtainable.* At the same time stimulants in moderate quantity, such as hot tea or coffee, may be given internally 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 is correct, as has been repeatedly and abundantly shown 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. In one set of experiments, of twenty animals 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. 49 Sprains. Sprains are sometimes quite trifling injuries, and require no treatment but a little rubbing or a little rest. At other times sprains are more serious and require as careful treatment as fractures do. In all forms of sprain, rest is the most important thing to be secured, and after this comes moist heat. To secure rest, a bandage will sometimes suffice, or a sling, or both. The ankle or foot may be helped by having a neatly folded towel (as they come from the ironing table) folded again so as to make a sort of trough splint and placed round it before the ban- dage is put on. For the purpose of applying moist heat, such a towel splint may be soaked with hot water and partly wrung out before it is applied to the sprained part. Besides this mode of treating sprains, wooden or other splints may be used if necessary and con- venient. In Sprains of the Wrist the hand and forearm may be laid on a straight splint, covered with cotton or wool 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 50 ACCIDENTS AND EMERGENCIES. hand and one or two round the forearm above the wrist — not over it. The bandage should cover all. Sprains of the Ankle should never be treated lightly. In them there is not unfrequently a frac- ture 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 usually suffice; for the second, applications of hot water; for the third, friction and kneading of the joint, with careful motion of it, and alternating hot and cold douching. But in few cases is it truer that " he who doctors himself has a fool for a patient." DISLOCATIONS. 51 Dislocations. A dislocation consists in the displacement of the articular or joint end of a bone. It 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. A dislocation can be detected by the occurrence of pain and compara- tive immobility of the joint. There is also deform- ity, which can generally be made apparent by com- paring the injured joint with the corresponding sound one of the other side. Dislocation of the Fingers can usually be reduced — or put in place — by strong pulling, aided by a little pressure upon the parts of the bones nearest the joint. These must then 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 unexpected circumstances. To reduce a dislocation of this sort, the sides of 52 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 must be made, first downward and then backward. It is important 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 is likely to be rewarded by having his thumbs mashed between the upper and nether millstones. He must be very quick, too, for the muscles do not wait, when they have been so unnaturally on the stretch, but bring the lower teeth instantly against the upper like a hammer. There is a 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 to 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 armpit 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 upward into its place. If this does not succeed readily, the DISLOCATIONS. 53 amateur surgeon had better let the dislocation alone. If it does succeed, the bone will go in with a snap. The arm should then be bound to the side, with the forearm carried across the chest and the hand placed on the opposite shoulder. Dislocation of other Joints ought not to be tampered with at all. The best that can be done for them is to put the parts in the position easiest to the sufferer, to surround the joint with cold, wet cloths, to which laudanum has been added, and to 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. 54 ACCIDENTS AND EMERGENCIES. Fractures — Broken Bones. Broken bones may be recognized by the occurrence of pain, of deformity, of bending where they ought not to bend, and of a sound and feeling of grating at the point of fracture. There are two important 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 muslin or linen between to keep the two skin surfaces from coming in contact, as this (especially in summer, when perspiration is free) FRACTURES — BROKEN BONES. 55 might cause irritation and even an inflammation of the skin. Then the whole upper arm should be 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. This last point is very im- portant, for if the hand is lower than the elbow it is likely to swell and become painful. Fracture of the Forearm. In this the arm should be bent to a right angle at the elbow, and placed in as nearly a natural position as possible, with the thumb pointing 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 snugly but not too firmly, and the hand carried in a sling which will raise it a little higher than the elbow. In extemporizing a sling for the arm, the sleeve of a coat or shirt may often be utilized by pinning it across the chest ; or part of the frock of a coat may be turned up and pinned to the body of it. In using a handkerchief or other cloth, this should be folded into a triangle and the long, straight edge placed next to the hand. The angle should be carried back toward the elbow and may be pinned fast there. This will support the whole of the forearm equally. Fracture of the Finger. A broken finger should be straightened out, and bound to a very 56 ACCIDENTS AND EMERGENCIES. light splint reaching from the wrist to the tip of the finger. The splint is more comfortable if applied to the back of the hand and finger. It should be, of course, padded. 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. As a temporary arrangement, the sufferer may then have both legs tied together, and lie on his side on a firm bed with the broken limb uppermost, the heel drawn up near to the buttocks, and the knee opposite the other knee. A pad must always be placed between the knees, or the pressure of one on the other may cause much discom- fort. Fracture of the Knee-pan. In fracture of knee-pan (or knee-cap) the whole leg must be bound to a straight splint placed at the back of the limb and going from the hip to the heel. A folded towel, or other pad about three inches thick, should be placed in the hollow at the bend of the knee, so that the leg may not be held absolutely straight \ for this position soon becomes very painful. The part under the heel must also be well padded. Then the whole leg should be raised at an angle of about forty- five degrees with the body, and supported with pillows. FRACTURES — BROKEN BONES. 57 Fracture of the Leg below the Knee. In this fracture the leg should be drawn down and placed in a natural position, using the sound leg for compari- son. Then a pillow should be placed under it. Under this, 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. 4.) A light piece of board, or several such pieces, may be bound on afterward to secure greater steadiness, or Fig. 4. 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 limb a little and lay it flat on a pillow, keeping it cool and moist. Breaks at or near a joint are especially serious, 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, E 58 ACCIDENTS AND EMERGENCIES. fortunately, very rare. They are hard to detect, and can be treated only by placing the sufferer in a com- fortable position and securing rest and coolness until a surgeon comes. If there is much pain opium in some form should be given — a tablespoonful of pare- goric or a half teaspoonful of laudanum, to an adult. 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 parallel to the ribs and ap- plied very snug, beginning at the lowest part of the chest and going up, each strip being made to overlap the one below about half its width. The strips should ex- tend from the spinal column to the middle 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. 5.) 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, and kept so until the surgeon comes. This is one of the Fig. 5. FRACTURES — BROKEN BONES. 59 best ways to treat a broken collar bone until it is quite healed. In Fracture of the Jaw, the parts of the bone should be put in position as nearly as possible, using the rows of teeth as a guide. Then the jaws should be closed and a bandage put round, so as to keep the two rows of teeth against each other. (See Fig. 6.) In Fracture of the Skull there is nothing the non- medical can do better than to place the patient on his back, with the head very slightly raised, and to apply cold, wet cloths to the head. If much time must elapse before a surgeon comes, it is well to give a brisk purge or an injection, so as to get the bowels well cleaned out. 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, he should not be disturbed until the surgeon directs it. Turning such a patient over upon his face may prove fatal, and must not be permitted. Compound Fractures, as has been remarked, are those in which there is an open wound commu- Fig. 6. 60 ACCIDENTS AND EMERGENCIES. 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 pre- caution that they must be thoroughly cleansed and kept clean, and the greatest care exercised to keep the sharp edges of the bone from doing any further damage. In all Fractures, cloths wet with 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. WOUNDS. 61 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 are 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 an injury of this sort. Contusions are sometimes very simple ; as in the illustration just given. Such contusions are best treated at first, when painful, by the application of cold, wet cloths. Pure laudanum, or laudanum and water in equal parts, is often a very acceptable appli- cation. 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, besides the external bruises, important internal organs may be injured. Evi- dence of this may be seen in spitting of blood or 62 ACCIDENTS AND EMERGENCIES. vomiting it, or passing it from the bowels or from the bladder; or there may be great depression. In such cases little 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 refer- ence may be made. Contused Wounds. These are cuts or tears accompanied with bruising of the tissues. They are to be treated like lacerated wounds (see page 64). 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 WOUNDS. 63 perhaps a bandage. If large, the edges should be brought as near together as possible, and supported so with strips of sticking plaster (as shown in Fig. 7), or bandages, or the hands, until the coming of a surgeon. If an entire part be cut off, such as an ear, or a nose, or a toe, or a finger, it should be cleaned with lukewarm water and put in its place, and kept warm, 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. Any person with fair skill and some nerve may stitch a wound, if it seems necessary, using a clean needle and plain black silk, and taking care to pass the stitches quite through the skin, and to adjust the edges accu- rately. Hairy parts should be shaved before stick- ing plaster is applied to them. On the head the hair can sometimes be used to tie across the wound, so as to bring its edges together. Cuts of the Walls of the Abdomen are often followed by escape of a portion of the bowels. These, if dirty, should be cleansed with warm water and a gentle effort made to restore them to their place. If this fails they should be covered with a clean white cloth soaked in warm water. The cloth should be kept warm and wet by means of a gentle stream of water or by laying on it a sponge soaked in warm water, which should be constantly renewed. 64 ACCIDENTS AND EMERGENCIES. 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, except that no attempt should be made to push it back, for this is more likely to do harm than to do good. 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 often require surgical skill. Until it can be ob- tained, however, the torn parts may be placed as nearly as possible in their natural position (after re- WOUNDS. 65 moving, with a stream of lukewarm water, squeezed from a sponge, any foreign matters that can be so dis- lodged) 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 may be placed over the injured parts. Punctured Wounds are made with sharp- pointed objects, like arrows, pins, needles, nails, tacks, fish-hooks, glass, thorns, or splinters. Pin Wounds rarely do much harm ; but they may be well squeezed while held in quite hot water, so as to provoke a pretty free flow of blood, which will wash out any poisonous matter that may have been deposited in the wound. If a Needle is run into the flesh and comes out, always examine it or its pieces carefully ; 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 probably 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. Wounds with nails or tacks are usually situated in the foot. In treating them one must try to make sure that no part of the nail or tack remains in the 66 ACCIDENTS AND EMERGENCIES. wound. After this it is often desirable to slightly enlarge the opening in the skin, to put the foot in hot water and squeeze some blood out. After this a dressing of hot water or a clean poultice may be used for a while to keep the skin from becoming so hard as to keep back any matter which forms. 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 before trying this. This may be done with a strong pair of nippers or cutting pliers (such as bell hangers use), or by means of a strong knife and a hammer. The latter method (of which the author has had per- sonal experience) is, however, an exceedingly painful one. After removing a fish-hook the wound may be treated as advised above for pin-wounds. Thorns rarely do much harm unless they are poisonous ; and poisoned wounds we shall consider later. Simple thorn-wounds may also be- treated as advised above for pin-wounds. Splinters are dangerous in proportion to their size and according to the part they enter. Small splinters may be picked out with a needle, or cut out with a sharp knife. Splinters under the Nails sometimes defy attempts at removal by the non-medical. But the way to succeed is to scrape the nail as thin as possi- WOUNDS. 67 ble 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 submit- ting to this little operation. Splinters of Glass are quite beyond most people's skill. If any pieces can be removed, this should be done. Afterward they are best treated with cold, wet applications, and left otherwise en- tirely to the surgeon. Splinters in the Eye should be pulled out, if possible. If not, a few drops of oil may be put in the eye and then the eyelid should be gently closed, and both eyes should be covered with a layer of cot- ton soaked in cool water, and a bandage placed round the head, so as to keep the lids as still as pos- sible. This bandage should not be too thick or put on too tight, and the application should be kept cool, with ice, if need be. 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 should be 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. Splinter- wounds may often be advantageously treated like nail-wounds. 68 ACCIDENTS AND EMERGENCIES. Poisoned Wounds may be considered here, as they are usually punctured. Bites of Venomous Serpents usually demand the prompt removal of the seat of the bite. 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 liga- ture, and, if small enough, thrust into the mouth and sucked hard, so as to extract the poison, or it may be soaked in hot water and squeezed so as to get some blood out. The immediate application of hartshorn to the wound 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 just large enough to cause drunken- ness, and the intoxication should be kept up until medical aid can be secured.* Stings of Tarantulas, Scorpions, Centi- pedes, Spiders, etc., are to be treated with cold, and hartshorn applied to the point where the sting entered. The stings of insects are rarely dangerous to life. They may be treated with cold, wet applications — wet earth is a very good one. The application of a drop of hartshorn or some wet salt often gives great relief. * This recommendation is open to certain objections, which need not be stated here. It will pass for a popular method of treating snake-bites. WOUNDS. 69 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, or squeezing them under hot water, and applying cold to them for a time. Bites of Dogs are a terror to many people, while others have little fear and are very seldom bit- ten. 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 dis- turbance may follow. In case of reasonable suspi- cion, the wound may be thoroughly cleansed and an application of hartshorn made to it, in addition to energetic sucking or soaking under hot water to ex- tract any irritating material which may have entered it. Dog bites should never be cauterized with lunar caustic (nitrate of silver). This is so generally done that the author must state that, after years of ex- haustive study of the subject, he is convinced that such cauterizations are worse than useless. They never do good and often do much harm. 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 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- 70 ACCIDENTS AND EMERGENCIES. 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- sonable suspicion that the dog was what is called "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 hydrophobia are spurious ; that is, they are not hydrophobia at all. The author has studied this subject with great care for years, and has become sat- isfied that the popular theory in regard to hydropho- bia is utterly wrong. He also believes it will some day disappear, as the belief in witchcraft — which not long ago was supported by the most respectable medi- cal, clerical, and popular authorities — has disap- peared. In most of the reported cases the patients have been alarmed by what they thought, or 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 ; and let the bitten person reflect how common are dog bites and how very few are the cases of even so-called hydrophobia. * * The author calls attention to the fact that so-called hydrophobia ex- ists exactly in proportion to the common belief in it and the amount of public discussion it gets. In Paris more cases occur than in any place of its size in the world, because there the medical men are continually keep- ing the subject before the people. In this country a few New York papers are more or less constantly doing the same thing ; though there has been a great improvement of late in the way they treat the subject. WOUNDS. 71 Gunshot "Wounds. This is another class of injuries occasionally met in civil life, though not common. Ordinarily little can be done for them, except by a surgeon ; and perhaps all that is advisa- ble before he comes is to note and remember the position 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 cold, 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 — teaspoon ful doses of wine, whisky, or brandy should be given, and heat applied to the surface of the body. (See " Shock".) 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 bleeding 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. 72 ACCIDENTS AND EMERGENCIES. Railroad and Machinery Accidents. 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 ob- tained 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 lace*rated 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, may be laid upon the wound and bound on loosely with an extemporized bandage. RAILROAD AND MACHINERY ACCIDENTS. 73 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 — that is, a finger and thumb ; and no one need be afraid to use these with reasonable care. They may be aided occasionally by touches with a clean linen or muslin cloth, or a clean sponge or small mass of cotton ; but these must be undoubtedly 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 also, 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 are most comforting — must be applied to the injury, F 74 ACCIDENTS AND EMERGENCIES. and symptoms of depression must be treated as de- scribed under the head of " Shock." 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 water, and laid upon a warm splint. If a finger or toe hangs by a mere shred, it may be cut off entirely. When Fingers or Toes are Torn off the stumps almost invariably require a scientific ampu- tation. But, until this can be decided upon, they must be cleansed, and treated with a cool, wet appli- cation 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 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 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. RAILROAD AND MACHINERY ACCIDENTS. 75 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 posi- tion 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 described for shock. Crush of the Arms or Legs is to be treated like crush of the hands or feet. But here the prostration is usually much greater, and the need for support, 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, or as is necessary to find out the nature of the injury or to control bleeding. 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 besides 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 may accompany a trifling gunshot wound. Or it 76 ACCIDENTS AND EMERGENCIES. 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 mine 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. In applying heat, care must be taken not to burn the patient ; for in a state of shock he may not feel pain from an amount of heat which would severely burn him. 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 RAILROAD AND MACHINERY ACCIDENTS. 77 of hot water may be given every ten minutes for sev- eral hours. Manufactories, mines, and railways ought to be furnished with appliances for the treatment of this condition and some one who knows how to use them \ for shock almost always follows severe railroad or machinery accidents, and is the most common cause of death after them, as any hospital surgeon could testify. 78 ACCIDENTS AND EMERGENCIES. 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 part. 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 tech- nical, 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) lie, one on each side of the windpipe, and divide and subdivide in all directions. The latter curve forward and come out from the chest over the first rib, and, passing under the collar-bone near the shoulder, pass down through HEMORRHAGE — BLEEDING. 79 the armpit and along the inside of the arm to the middle of the front of the elbow, and here divide into two branches. These pass along the front of the forearm, one on the thumb side, and the other on 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, en- tering 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 or- gans, and near the lower end of the backbone divides and sends a large vessel out through each groin into the thigh. Each of these passes 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 inner ankle bone into the inner side and sole of the 80 ACCIDENTS AND EMERGENCIES. 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 capillaries are a sort of splitting up of the smallest arteries, so, on the other hand, by the confluence of a number of capillaries, larger branches 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 that of the arteries. Of veins there are two sets : the deep, which lie alongside the arteries, and the superficial, which lie near the sur- face just under the skin. Each principal artery has at its side at least one vein of corresponding size. 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 HEMORRHAGE — BLEEDING. 81 lungs to be aerated ; from the lungs it is collected and emptied into the left side of the heart ; and from the left side, as we have seen, it is pumped out to begin the circuit through which we have just traced it. The frontispiece will give a fair idea of the course of the main blood vessels, and may make clearer what may not have been understood from the pre- ceding description. It may be observed that the position 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 defense. 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 82 ACCIDENTS AND EMERGENCIES. stream. Blood from capillaries is of a color be- tween these two, and it oozes out. Capillary Hemorrhage follows every cut. The 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 firmly 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, continuous pressure upon and below the wound generally suffice to stop it. A folded linen or mus- lin cloth, bound on dry, with moderate firmness, or direct pressure with a finger, will usually stop any bleeding from a vein. 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, for the blood passes up in the veins and not down. HEMORRHAGE — BLEEDING. 83 A wound of the jugular vein, on the side of the neck, is usually followed by dangerous hemorrhage. This is to be treated with a pad and press-ure, which can be best made with one finger laid above and one below the wound. Hemorrhage from the Arteries may be very dangerous. Here the blood is bright red, and spurts in a stream or leaps in jets from the divided vessel. If it be from a large artery, like 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. In- deed, 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 84 ACCIDENTS AND EMERGENCIES. 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. For wounds high up in the neck or about the jaw, pressure may be made with the thumb at the root of the neck, just outside the windpipe and near the col- lar bone, as shown in Fig. 8. One thing must be remembered in all cases of hemorrhage, that is, never to disturb any clots that have formed ; for they are Nature's means of stopping hemorrhage. Another is that fainting sometimes puts a stop to bleeding, and so far is an aid to the professional or amateur surgeon. Every one may, while awaiting skilled aid, do something when the arteries of the limb are cut. The first duty in all such cases is to be cool as possi- ble, 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. 10). 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. 85 For Wounds of Arteries of the Finger, pres- sure may be made on the side that is cut by seizing the finger between a thumb and finger and pinching it, or by wrapping a cord round, or slipping on a rubber band. In wounds of the thumb, pressure must be made on the front of the thumb. 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 hemorrhage. For Wounds below the Elbow, first grasp the upper part of the arm with the fingers and thumb, as shown in Fig. 10, and squeeze as hard as possible ; then let some one make a thick, hard knot, as big as an egg 9 in the middle of a handkerchief, 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. 9). This, if successfully done, will obstruct the Fig. 9. 86 ACCIDENTS AND EMERGENCIES. main blood vessel (the brachial artery), which in this place lies in the middle line of the bend of the elbow. For Wounds in the Upper Arm, pressure may be made against the bone on the inner side and just Fig. io. Fig. ii. below the swelling muscle, which most people are aware is called the biceps, as shown in Fig. io. A knot as big as a fist may then be made in any piece of HEMORRHAGE— BLEEDING. 87 cloth and shoved hard up into the armpit, and the elbow brought straight down and held or bound firmly against the side of the chest. If either of these methods fail, or cannot be car- ried out, the " Spanish-windlass " may be used. To do this, place some hard, round body, like a stone, in a large part of a handkerchief folded diagonally, or knot the middle and carry the ends 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 upper 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 handkerchief, till the blood stops flowing, but no more! (See Fig. n.) 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 suggested 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 88 ACCIDENTS AND EMERGENCIES. the bending of the knee will soon become intolerably painful. For Wounds in the Thigh, pressure must be made in the hollow immediately 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. 12. 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 suc- ceed 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. This can be made with a dry pad Fig. HEMORRHAGE BLEEDING. 89 bound on with a bandage, or held on with a finger or two. Recapitulation. — To go over this briefly again : Re- member, first, to keep cool ; second, that the prin- cipal 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 with 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-wind- lass ' ' is to be applied at the same points. 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, this being kept in place by pressure with a bandage or handkerchief, or the cut part may be forcibly compressed in any way, or a finger may be thrust into the wound and held wherever it seems to do the most good. Finally, let it be remembered that clots are not to be disturbed, that raising a limb will often put a stop to even severe bleeding, and that fainting may put an end to hemorrhage, as well as that when conscious- ness is restored the bleeding may recur. So this possibility should not be overlooked. The treatment of a faint under these circumstances — if it is so grave or so prolonged that it must be treated — is the G 90 ACCIDENTS AND EMERGENCIES. 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. SPECIAL HEMORRHAGES. 91 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. Until it arrives the best thing that can be done is to put a cold key or a cloth dipped in cold water to the nape of the neck. If this does not soon stop the bleeding, salt and water (a teaspoonful to a cupful) or vinegar may be snuffed up the nose. A dessert- spoonful of alum in a cupful of 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. Bleeding after Extraction of a Tooth is best treated by pressing a plug of cotton firmly over the bleeding point, and holding it there with the finger until a surgeon can be had. 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 92 ACCIDENTS AND EMERGENCIES. sitting posture, and the swallowing of lumps of ice. The application of cold to the chest, although often recommended, is rarely advisable. Asaltspoonful of salt and a teaspoonful of vinegar may be given every fifteen minutes ; but most hemorrhages from the lungs stop in a little while without any treatment. In Hemorrhage from the Stomach the blood is usually very dark, looking like coffee grounds. 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 teaspoon- ful 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 injections of a teacupful of ice water and the application of ice to the abdomen. Fortunately, these hemorrhages are rarely dangerous, and the tendency to them can often be corrected by the use of simple laxatives and regular attention to the move- ments of the bowels. In Internal Hemorrhage of women ice-cold cloths may be placed upon the abdomen. One of the most efficient modes of checking such hemorrhages is to use large injections of water as hot as can be borne, directed to the source of the bleeding. Rest in bed, without a pillow, and with the head lower than the body, must also be secured. TRANSPORTATION OF INJURED PERSONS. 93 Transportation of Injured Persons. 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, not alongside of him, but 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 backward over it, and in doing so may stumble. One person should, if possible, give his whole attention to supporting the injured part when a person is put upon a stretcher. A stretcher should not be carried on the shoulders, but should be held with the hands or supported by straps passing over the shoulders of the bearers. The bearers should also march in broken step and not "keep time." In going up hill the patient's head should be in advance, in going down hill, his feet. 94 ACCIDENTS AND EMERGENCIES. 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 57). Where an injured person can walk, he can get much help by putting his arms over the shoulders and round the necks of two others. In case of an injury, when walk- ing is impossible and lying down is not absolutely ne- Fig. 13. Fig. 14. cessary, 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 him- self; or two men may carry him seated on their inter- locked hands, in the way known to children as " Lady TRANSPORTATION OF INJURED PERSONS. 95 to London." For this, each of two persons, stand- ing face to face, should grasp his right forearm with his left hand (its back uppermost), then he should grasp his companion's free left forearm with his own free right hand (also with its back uppermost) as Fig. 15. shown in Fig. 13. When no litter can be obtained, 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. 14. Another mode of carrying an injured person is that shown in Fig. 15. One man 96 ACCIDENTS AND EMERGENCIES. passes his arms from behind under the armpits and clasps his hands over the chest of the injured person, and raises him from the ground, while another carries one leg over each of his own arms. In carrying an injured person upon a litter, or what serves for one, the bearers, as stated above, ought not to keep step; but when they are not using a litter, they should keep step. poisons. 97 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. Unknown Poisons. If vomiting has set in, this should be encouraged ; if not, it must be pro- voked. The simplest way to do this is to give large draughts of lukewarm water, and to tickle the throat. A teaspoonful or two of ground mustard, or a tea- spoonful of powdered ipecac, or a tablespoonful of the syrup of ipecac may be stirred up in the water. Further, let it be remembered that there is no occa- sion 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 is an antidote for many poisons. The quantity used must * 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. 98 ACCIDENTS AND EMERGENCIES. be large \ the sufferer must be urged to drink and drink, a large quantity at a time, and be made to vomit several times — not pushing this to exhaustion, however. After copious vomiting, soothing liquids should be given — oil, milk, beaten-up raw eggs, or flour and water — 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. Or the spirits may be given mixed with a little hot water. Warm coverings are not to be for- gotten ; 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. (See " Shock. ") Oil of Vitriol {sulphuric acid) and Nitric and Muriatic Acids are heavy, sometimes yellowish- looking, fluids; the first, as its name implies, not poisons. 99 unlike oil in appearance, but very heavy in a bottle. The others are lighter, and give off extremly pun- gent, irritating fumes. All discolor anything on which they fall ; the first blackens white pine wood, and others turn it yellow. All burn horribly and leave no doubt of their caustic nature. For these the proper treatment is to give an alkali. A tablespoonful of hartshorn may be mixed with two teacupfuls of water, and given ; or large quantities of baking or washing soda, magnesia, potash, whitewash, chalk, tooth-powder, whiting, plaster, soap, or even wood ashes, stirred up in water. In poisoning with acids vomiting should not be provoked, because there is no need to bring back the acid if it has been fully neutralized, and there is no use in doing so if it has not been. After using the alkaline antidote, the bland fluids mentioned above may be administered, and rest secured and stimula- tion employed, if necessary. Oxalic Acid comes in small, heavy, bright, color- less crystals, making a clear, rattling sound when shaken 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. * Lime-water may be made in an emergency by putting a piece of lime about as large as a walnut in a pint of water and shaking them well together for a few minutes. 100 ACCIDENTS AND EMERGENCIES. Prussic Acid is usually immediately fatal. The cyanide of potash (used by photographers) and oil of bitter almonds are poisonous because of the prussic acid they contain. Poisoning with either of these must be treated with an emetic and with bland liquids and stimulants. Hartshorn may be inhaled from a handkerchief. Carbolic Acid and Creasote are usually in so- lution, as a thick, clear, pink, or dusky fluid. When taken by the mouth they cause whitening and shrivel- ing of the mucous membrane lining it, with intense burning, and then numbness. There are also nausea, weakness-, depression, and sometimes actual collapse. They are very dangerous poisons, because they act as caustics and also benumb the stomach, so that it is hard to provoke vomiting. This must be at- tempted, however, and Epsom salts (a tablespoonful for an adult) should be given dissolved in water, followed by large draughts of oil, white of egg, magnesia and water, or milk. Rest, warmth of the body, and stimulation must also be secured if there is depression. Alkaline Poisons. — The strong alkalies are am- monia, 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 containing these substances are sometimes swallowed by mistake. The alkalies usually burn intensely. They must POISONS. 101 be combated with an acid. Vinegar can generally be had ; and there is nothing better. It should be given undiluted and freely — a half teacupful at a time. 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 may do harm if pushed too far ; and this part of the treatment may well be left to nature. Bland acid or oily drinks may be given, and rest and stimulation secured if necessary. Arsenic is a white, sweetish powder, and is used in fly-papers and powders, to destroy domestic pests, such as rats, bugs, and roaches. It is also found in some paints and in wall-paper or glazed toy-papers. It usually excites vomiting and violent pain in the stomach. At once large quantities of milk, white of egg, flour and water, oil, or lime-water must be given. The vomiting must be encouraged or provoked, and dialysed iron given. This can now be obtained at any drug store, and should be given freely, in tablespoon- ful doses, each dose being followed at once by a tea- spoonful of common salt in a teacupful of water. If it 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 provoked, and followed by a dose of castor oil. Paris Green and Fowler's Solution are arsenical preparations. If taken as a poison, the 102 ACCIDENTS AND EMERGENCIES. treatment is the same as for poisoning with simple arsenic. Sugar of Lead comes in white lumps or powder. Poisoning with lead is to be treated with vomiting, Epsom salts, milk, eggs, and castor oil. Corrosive Sublimate (bichloride of mercury) comes in small, colorless crystals, or in a clear solu- tion ; it is also contained in most of the " antiseptic tablets" used in making washes and dressings for surgical cases. For corrosive sublimate poisoning, vomiting must be provoked and some form of tan- nic acid given. Strong tea is the handiest thing containing this, and its administration should be followed by giving eggs and milk or flour and water freely. Tartar Emetic, a white powder, is best treated in the same way. Phosphorus is found in the heads of matches, and it is contained in some rat-poisons. It is a poison which acts slowly, and affords ample time for securing medical advice. But five-grain doses of sulphate of copper, dissolved in water, maybe given, at intervals of ten minutes, until vomiting comes on. Half-teaspoonful doses of old oil of turpentine are said to be very useful in poisoning with phosphorus. Then a dose of magnesia should be administered ; but no oil. Croton Oil is sometimes contained in liniments. It produces great pain in the stomach with griping and purging, and depression. It should be treated POISONS. 103 with an emetic, if recently taken, and bland liquids, like oil or white of egg, and the administration of stimulants and of some laudanum or paregoric if necessary. Lunar Caustic (nitrate of silver) is sometimes swallowed. The antidote for this is a strong brine of salt and water, given again and again ; and vom- iting should be provoked until the vomited matters cease to have a look like thin milk. Afterward a dose of castor oil may be given. Iodine, in the form of a tincture, is also some- times swallowed by mistake. The antidote for this is starch and water, or plenty of milk, or flour and water. Opium Preparations are opium, morphine, laud- anum, paregoric, black drop, chlorodyne, some lini- ments, and many nostrums sold as soothing-syrups, pain-destroyers, and drops for infants. Opium pro- duces 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 persistently, and vomiting produced over and over again. 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 breathing. The custom of walking a patient up and 104 ACCIDENTS AND EMERGENCIES. 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 ex- cite reflex acts of deep breathing. The next best thing to lay the patient upon a lounge and slap his skin from time to time with the back of a broad brush or with a slipper. This is all the rousing that is necessary as long as the breathing keeps above ten to the minute. Should it fall below this, or if the breathing should cease, artificial respiration should be employed. (See page 14.) Chloral is a damp, colorless, crystalline substance, usually seen in solution. Its symptoms and treat- ment are similar to those of opium. Belladonna, or its active principle, Atropia, is so much used in medicine that accidents sometimes occur from its misuse. Symptoms of poisoning with belladonna are a dilated pupil, a peculiar flush of the face, dry throat, unsteadiness of gait, and delirium. The treatment consists in giving an emetic, followed by rest, warmth to the extremities, and a moderate quantity of strong coffee. 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 POISONS. 105 bromide of potash, or twenty grains of chloral, or both, to an adult, and one-quarter as much to a child for each five years of its age. 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 as good ventilation as possible. Aconite and Veratrum Viride are sometimes contained in liniments, and in this way come to be 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 physician imperative. If there is depression, warmth should be used, as described when speaking of unknown poisons. Hemlock, Deadly Nightshade, Jamestown (or Jimson) Weed, Monkshood, and Toad- stools are sometimeseaten without knowledge of their poisonous character. Tobacco, Indian Tobacco, Poison Sumac, and other plants sometimes cause poisonous effects. Nightshade, Jamestown weed, and monkshood produce widening of the pupil and some delirium — usually of a laughing sort — and often H 106 ACCIDENTS AND EMERGENCIES. a disposition to pick at imaginary objects, but no sleepiness. All are likely to produce deep depression, and must be treated with vomiting, followed by stimulation and warmth, very much as in the case of belladonna 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- 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 "In- toxication." Page 38.) Decayed Meats or Vegetables usually excite vomiting, which should be encouraged until the stomach is empty, and followed by a dose of castor oil and a teaspoonful of powdered charcoal. Recapitulation. 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. An- other thing which may be remembered is that acci- dental poisoning is very rarely fatal. In seventeen years of practice the author has never seen a case of accidental poisoning in which the patient did not POISONS. 107 recover. So, in case of poisoning, the treatment here suggested may be followed, and it may generally be expected that the patient will get well. 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. ( Emetic, Unknown < Bland liquids, (. Stimulation. Acids — 1 f An alkali, Sulphuric, | j Bland liquids, Nitric, | j Rest, Muriatic. J [ Stimulation. ( Emetic, Oxalic Acid < Chalk, ( Bland liquids, f Emetic, Carbolic Acid, \ SPTi — S' Creosote. j \ ^liquids, [ Stimulation. Prussic Acid — ~| ( Emetic, Oil of almonds, > -< Bland liquids, Cyanide of potash. ) ( Stimulation. Alkalies — ") r . . , , . , Hartshorn, [ £ n acid (vinegar), Soda, L \ |land liquids, L ' [ Stimulation. Arsenic— ~\ [ Emetic > Paris green, J J?ialysed iron and salt, Scheele's green, \ \ pastor oil, Fowler's solution. J c * • 1 ♦ • J y Stimulation. f Emetic, J Epsom salts, j Bland liquids, I Castor oil. Sugar of Lead.. Corrosive Sublimate, Tartar Emetic. ) I f Emetic, Strong tea, Raw eggs and milk, j Castor oil, L Stimulation. 108 ACCIDENTS AND EMERGENCIES. POISON. TREATMENT. f Emetic, Phosphorus \ | l i P p h e a n \ e in ° e f C ° Pper ' [ Magnesia, but no oil, ( Emetic, Croton Oil -< Bland liquids, ( Laudanum or paregoric, f Salt and water, Lunar Caustic \ J Castor oil, (nitrate of sil ver). j j Bland liquids [ Emetic. ( Emetic, Iodine < Starch and water, ( Bland liquids. Opium — "] Morphine, f Emetic, Laudanum, )■ < Strong coffee, Paregoric, etc. | ( Keep up breathing. Chloral. J Belladonna— \ J w™ 6 ^ f Emetic, Strychnine - ■< Purgative, (. Absolute quiet. Aconite, \ j S^V VeratrunViride.) \ H^dtow"' Jamestown Weed, ~\ Hemlock. , ^ Nightshade, \ J a? etl ?\- Toadstools, I Stimulation. Tobacco, etc. J Alcohol { |"5g=- . f ( Hartshorn and water. Emetic, Decayed Meat or Vegetables. -^ Purgative, Powdered charcoal. «■{ To provoke vomiting, warm water may be used with or without ground mustard (a tablespoonful to 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 — not too far, how- POISONS. 109 ever. 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, flour and water, etc. Stimulants are tea, coffee, whisky, wine, etc., or hartshorn. Of the last, a half teaspoonful in a tea- cupful 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 conve- niences 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 a drop for each year of a child's age. Such doses may be repeated in half an hour if the pain continues to be severe and there is no drowsiness. 110 ACCIDENTS AND EMERGENCIES. Description of Poisonous Plants. Poisoning is sometimes caused — especially among children — by eating parts of certain plants which grow wild in the woods or fields, or by the roadsides as well. A few of these may be described, so that they may be avoided if possible, or — in case of accident — that it may be known what has done the mischief. Bitter-sweet, Woody Nightshade (Solanum dulcamara) must not be confounded with the culti- vated plant called " bitter-sweet. M The woody nightshade is a shrubby, climbing plant, bearing blue or purple flowers, with an orange-colored centre, and oval, bright red berries, that are poisonous. Deadly Nightshade (Atropa belladonna) grows three or four feet high, has large, dark green, pointed leaves growing on downy stems, with drooping, bell- shaped flowers and blue-black berries (when ripe), marked with a deep furrow. (Fig. 16.) Fool's Parsley (^Ethusa cynapium) grows about two feet high in waste grounds, and looks something like ordinary parsley (Apium petroselinum), but has a disagreeable odor. Its leaves are compound and dark green, and its flowers are white. DESCRIPTION OF POISONOUS PLANTS. Ill Foxglove (Digitalis) is a European and Asiatic plant, cultivated in gardens in various parts of the world. It grows three or four feet high. It has large, dull-green, downy leaves and handsome, bell-shaped crimson or purple flowers, with beautiful spots within, arranged in a " spike. " (Fig. 17.) mil A Fig. 16. Hemlock. — Ground Hemlock, Dwarf Yew (Taxus Canadensis), looks like a dwarf spruce tree. It is an evergreen, with small red and juicy berries (drupes) concave on the summit. The leaves and black seeds are poisonous. 112 ACCIDENTS AND EMERGENCIES. Hemlock. — Poison Hemlock (Conium macu- latum) grows from three to six feet high, with many branches, the stems of which are smooth, round, and spotted with purple. The leaves are compound, and bright green. It has small, white flowers, arranged sfr - "?~c J in umbrella shape. The plant has a disagreeable odor. (Fig. 18.) Hemlock. — Water Hemlock, or Spotted Cow-bane (Cicuta maculata), is a plant growing DESCRIPTION OF POISONOUS PLANTS. 113 from three to six feet high, in damp ground, with slender, compound, notched leaves, on a hollow stem, and small, white flowers, arranged in shape like an umbrella. The root is thick and fleshy, and Fig. 18. very poisonous. The leaves are poisonous, and often prove injurious to cattle. Henbane (Hyoscyamus) is a plant which grows about two feet high, with large, pale-green leaves with 114 ACCIDENTS AND EMERGENCIES. scalloped edges. The flowers are straw colored, rimmed with a purple, urn-shaped cup. (Fig. 19.) Indian Tobacco (Lobelia inflata) grows about Fig. 19. two feet high, with a, rough, straight stem, pointed, notched, and hairy leaves, with small, pale blue DESCRIPTION OF POISONOUS PLANTS. 115 flowers springing from the junction of a leaf-root with its stem. Indian Turnip, or Jack in-the-Pulpit (Arum), grows about a foot high, with a peculiar flower on a straight stem, with scarlet berries. The root is turnip-shaped and has a burning taste. Fig. 20. Jamestown or "Jimson" weed, Thorn- apple (Stramonium), grows about three or four feet high, with tough skin, ragged leaves, and a white or tinted flower like a very tall, slender vase. A peculiar feature of the Jamestown weed is the seed- pod, which is green when young and gray-brown 116 ACCIDENTS AND EMERGENCIES. when mature and dry. It is very rough and thorny outside and contains seeds that are soft and white when young, and become hard and black when old. (Fig. 20.) Monkshood (Aconitum napellus) is a native of the ' mountainous parts of Europe and Asia. It grows about four feet high, with leaves deeply cleft into five parts. Its flowers are dark blue, with a vaulted upper sepal, like a monk's cowl. They are arranged in the form called a spike — several flowers along a common stem. Poison Ivy, Poison Oak (Rhus toxicodendron) is a climbing shrub sometimes confounded with the Virginia creeper. It is distinguished from the latter by having its leaves arranged in clusters of three, while those of the Virginia creeper are in clusters oi five. Its berries (drupes, botanically) are dull white, while those of the Virginia creeper are dark blue. The poison-ivy causes a painful, itching, and very troublesome eruption in some people when it is touched, or even when it is approached. Poison Sumac (Rhus venenata) grows ten or fifteen feet high, with wide, spreading branches, leaves three inches long and about half as wide, with long, red stems and small, greenish flowers, with fruit like a cherry (drupe) but the size of a pea. The whole plant is very poisonous to taste or touch and has a very disagreeable odor. Poke-berry (Phytolacca decandra) is a very DESCRIPTION OF POISONOUS PLANTS. 117 common shrub in North America, growing from four to eight feet high, with a smooth stem, often of a deep purple color, with greenish-white flowers, and Fig clusters of dark purple berries at the end of delicate stems. The plant is not very poisonous, but may cause dimness of vision and even convulsions. Poke-root, Indian Poke, Hellebore (Veratrum 118 ACCIDENTS AND EMERGENCIES. viride, V. album) grows from three to six feet high, with large, coarse, oval, pointed leaves, with straight veins, with many small, green flowers, arranged at the top of the stem on little branches (panicle). It is an exceedingly poisonous plant. (Fig. 21.) Wild Parsnip (Pastinata sativa) is a plant about three feet high, with compound leaves made of small leaflets arranged along a grooved stem; they are dark green, and downy on the under side. The flowers are yellow and grow in small clusters. The root is tapering, like that of the cultivated parsnip. The root of the wild parsnip, unlike that of the food parsnip, has a harsh and bitter taste. Wolfs-bane (Aconitum uncinatum) grows wild in parts of the United States. It is a plant about two feet high, with dark green leaves divided into three or five points (palmate), and with three or four large purple flowers at the end of each branch. DOMESTIC EMERGENCIES. 119 Domestic Emergencies. No less important than the emergencies thus far con- sidered, most of which have a sort of public signifi- cance, are a few more which usually occur within the limits of the household, and try the knowledge and patience of anxious parents. If these emer- gencies arose only when skilled assistance could be had in a moment, their consideration might be omitted from a book like this. But they have a way of pre- senting themselves at the dead of night, in travel- ing, 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 interests 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, and 120 ACCIDENTS AND EMERGENCIES. to a child a drop for each year of its age. At the same time heat must be applied to the stomach. For this purpose 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 composed of a small tea- cupful of warm water or milk, to which a tablespoonful of tincture of asafoetida has been added, often gives great relief. Colic causes violent griping pain in the abdomen. It is usually due to something indigestible that has been eaten. It should be treated with hot applica- tions to the abdomen, such as have just been men- tioned. A purgative, such as castor oil or castor oil and spiced syrup of rhubarb, may be given by the mouth, and an injection of water and asafoetida administered, as described in speaking of cholera morbus. Vomiting, or Nausea, due to something ob- jectionable 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 cold 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 DOMESTIC EMERGENCIES, 121 sprinkled with a tablespoonful of turpentine or some red pepper. A lump of ice held against the pit of the stomach sometimes does much good. The sufferer should, if possible, 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 glycerine and castor oil acts equally well. Nothing acts better for adults or infants than a tenth of a grain of calomel, given every half hour till it produces a free movement. A teaspoonful of a mix- ture of equal parts of sweet oil and castor oil, or of spiced syrup of rhubarb and castor oil, for an infant, and two tablespoon fuls of the same mixture. for an adult, is often very useful. 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 laud- anum have been added, often gives immediate relief, i 122 ACCIDENTS AND EMERGENCIES. For a child over two years old, half a drop of laud- anum may be given after each passage, until the diarrhoea seems checked or there is some evidence of drowsiness. A simpler remedy, which often acts well, is a tablespoon ful of raw flour in a glassful of cool water, to be taken in two doses, half an hour apart. Dysentery sometimes follows a simple diarrhoea, and sometimes comes on suddenly, with fever and often with screaming in children. There is a strong and constant inclination to have the bowels moved, but the passages are usually small, and the movements accompanied with severe straining and pain and the discharge of some blood. The treatment is best begun with a purge of castor oil and rhubarb. Then laudanum may be given by the mouth (half a teaspoonful to an adult, and to a child a drop for each year of its age). Great relief is sometimes afforded by large injections of cold water very slowly and gently given, or small injec- tions of thin boiled starch (six tablespoonfuls for an adult and one for an infant), with laudanum in the same dose as when it is given by the mouth. Rest in bed and liquid food are indispensable parts of the treatment. The discharges from the bowels ought to be disin- fected by adding boiling water to them or chloride of lime. The vessels used should also be scalded after every emptying. DOMESTIC EMERGENCIES. 123 Croup. Attacks of spasmodic croup, though very alarming, are rarely dangerous. There is- prob- ably 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 accomplished by allaying the alarm of the child and by diverting its mind. The reading of some favorite story or the exhibition 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. After the at- tempt at provoking vomiting it is well to give a purge like castor oil and spiced syrup of rhubarb. 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 until 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 124 ACCIDENTS AND EMERGENCIES. renew the hot cloths as soon as they begin to grow cold, but besides 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. Whooping Cough. Children with whooping cough should go out in fine weather ; in bad weather they should be kept in a well-ventilated room in a warm and (if possible) moist atmosphere. Moisture can be secured by having a flat vessel containing water upon the stove, or by putting a basin of water on a chair in front of a register and hanging a long towel over the back of the chair with one end in the water. The towel may be dipped in the water from time to time as it becomes dry. In whooping cough, the bowels should be kept open, and only good, digestible food should be given. A belladonna plaster on the chest sometimes does good, and if the paroxysms of coughing are very severe, some form of opium may be given. Ten drops of paregoric may be given to a child two years old and repeated in an hour. A child six years old should have half a teaspoon ful at a dose. In whooping cough there is a strong nervous ele- ment, 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, DOMESTIC EMERGENCIES. 125 to be at once separated from other children, for its own good and for theirs. Asthmatic Attacks may be treated in several ways. One method is founded upon the fact that asth- ma 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. Oc- curring, as it usually does, at night, the darkness, the surprise, the absence of surrounding activities, in- crease 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 dimin- ishing and finally disappearing. If he be a smoker, his cigar or pipe will help him in this emergency. 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 ascend- ing 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 some hot coffee or hot sweetened water, and by applying heat to the body by means of a bath or hot cloths or bottles, 126 ACCIDENTS AND EMERGENCIES. 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 or a knitting 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 cleaned out. Then the point of the 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 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, after cleaning it thoroughly, 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 may be extracted, or at least cleaned out and packed with cotton and oil of cloves, as described in speaking of DOMESTIC EMERGENCIES. 127 toothache. Many earaches depend upon a diseased condition of the throat or back part of the nose, and these should always be investigated in case of ear- ache. For the pain of earache, a folded cloth, wrung out of hot water, with a teaspoonful 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, if necessary, pare- goric or laudanum to give relief from pain. It is a good plan to pour into the ear a few drops of sweet oil, quite hot (not hot enough to burn, of course), to w r hich an equal part of laudanum has been added after the oil has been warmed. 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 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 128 ACCIDENTS AND EMERGENCIES. dry, may do much good, or painting the painful part lightly with oil of peppermint. On the other hand, cold applications may do more good, although this does not often happen. Convulsions, from various causes, are to be treated as described at page 36. Fever. It often happens that children unex- pectedly develop symptoms of fever when there is no physician at hand. In such cases, it is well to know what may be done before medical advice can be obtained. The first thing to do is to get such a child undressed and to give it all the cool water it desires to drink. Then a purge should be given, nothing being better than a mixture of equal parts of castor oil and spiced syrup of rhubarb, or a tenth of a grain of calomel every half hour. At the same time a teaspoonful of sweet spirits of nitre may be put in a glassful of cool water, and a dessertspoonful of this mixture may be given every fifteen minutes or half hour. This acts gently on the skin and kid- neys, and often does much good. A feverish child ought not to be covered up too warm in bed. It will not " take cold M if it is kept moderately cool, and it will be much more comfort- able. Nature prompts persons in the heat of fever to get rid of most of their covers; and nature is a pretty safe guide in the treatment of disease. For food, a feverish child should be given nothing but milk at first, and nothing at all if it does not DOMESTIC EMERGENCIES. 129 want to eat. Coolness (not coldness, of course), plenty to drink, nothing to eat, and a good cleaning out of the bowels are the things most important for cases of simple fever. Many fevers disappear promptly under this treatment, and no case of serious fever is prejudiced by it. 130 ACCIDENTS AND EMERGENCIES. 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 mentioned which would very much facili- tate the treatment if they were accessible. Emergency 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. Absorbent cotton. 2. Roll of old muslin or linen and one of soft flannel. 3. Bandages, 2j4 inches wide and 6 yards long, rolled up. 4. Rubber adhesive plaster, on a spool, in a strip two inches wide. 5. Oiled silk. 6. Sharp scissors. 7. Pins (ordinary and small safety pins). 8. Needles, threaded with stout thread — white. SUPPLIES FOR EMERGENCIES. 131 9. Cosmoline or vaseline. 10. Alum. 11. Ammonia — aromatic spirits of. 12. Calomel. 13. Castor oil. 14. Cloves — oil of. 15. Hartshorn. 16. Ipecac — syrup of. 17. Laudanum. 18. Lime-water. 19. Mustard. 20. Nitre, sweet spirits of. 2i. Paregoric. 22. Rhubarb — spiced syrup of. 23. Soda — bicarbonate of. 24. Turpentine. 25. Whisky. Of medicines, a convenient quantity to have is two fluid ounces ; except in the case of oil of cloves, of which a fluid drachm is plenty. Aromatic spirits of ammonia and hartshorn and the spirits of nitre ought always to be kept in bottles having good rubber or glass stoppers. The laudanum and paregoric bottles, 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. 132 ACCIDENTS AND EMERGENCIES. For the convenience of readers of this book, the author has had made a case containing the remedies and appliances named above (except the old muslin). This case* (Fig. 22) is made of leather or hard wood polished, and measures 11^ X 1% X aY\ inches. It contains 20 two-ounce bottles with glass Fig. stoppers, a glass jar for vaseline, and two spaces for surgical appliances. Several of the bottles are left unfilled for other articles which may be desired by the purchaser. * The Emergency Case, with contents, can be purchased of the E. A. Yarnall Co., 1020 Walnut Street, Philadelphia, for ten dollars. SUPPLIES FOR EMERGENCIES. 133 USE OF THE EMERGENCY CASE. i. 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 water 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 sat- urated.* For padding splints, or making cushions to prevent pressure of any kind, ordinary cotton is better than 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, and to prevent injurious motion. Roller bandages may be made of the follow- * Tn buying absorbent cotton, it should always be tested. If good, a lit- tle pinch of it dropped on water will become wet and sink in a second or two. Cotton which floats dry on the surface is not fresh and is not fit to be sold as absorbent cotton. 134 ACCIDENTS AND EMERGENCIES. ing sizes, according to the part of the body for which they are required: — For the finger, % inch wide and I yard long. " arm, 2]/ 2 inches wide and 4 to 6 yards long. " leg, 3 inches wide and 6 to 8 yards long. " chest, 4 to 5 inches wide and 8 to 12 yards long. " head, 2 X / Z inches wide and 4 to 6 yards long. The arm-size bandage is the one of most general usefulness, and the most convenient to have in an emergency case. The simplest way to apply a bandage 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 accom- plish 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 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 down- ward so as to make a sort of inverted V — so, \. On now carrying the bandage round the part, it will be found that it comes to the front just overlapping the preceding turn, and the same process can be re- SUPPLIES FOR EMERGENCIES. 135 pcated until the whole bandage is neatly applied. (See Fig. 23.) At joints, like the ankle, knee, and elbow, the bandage may make a sort of figure 8, the middle or crossing part being in the bend of the joint, and the two loops, one above and one below it. (See Fig. 24.) Fig. 23. Bandages should never be put on so tight as to cause pain, and should never be drawn tighter above than below. Bandages may be fastened with pins, with strips of adhesive plaster, by stitching, 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 to- gether. For narrow bandages, the latter is the sim- plest plan ; for wide ones some one of the others is better. 136 ACCIDENTS AND EMERGENCIES. The width of 2^ 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 Fig. 24. razor or a sharp knife, just as one would cut a sau- sage. This quickly and easily makes two good fin- ger 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 it is to be ap- SUPPLIES FOR EMERGENCIES. 137 plied to a hairy part, the hair should first 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. Another point to be remembered is that, in chang- ing adhesive plaster dressings, only as 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 re- moved together. The plaster is most convenient to use in strips, which can easily and without waste be cut smaller ; while additional strips may be applied side by side if a greater width is wanted. 5. Oiled silk is used to retain heat and moisture after poultices or other warm wet dressings are applied. 6, 7, 8. As to the use of scissors, pins, and needles, it may be stated that 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. 9. Cosmoline and vaseline are excellent as applications to a variety of wounds or injuries, though both are somewhat irritating to the eye or the inside of the nose. As they never become ran- cid, they are preferable to cold cream for an emer- gency case. 10. Alum (in powder) added to water is useful J 138 ACCIDENTS AND EMERGENCIES. for checking bleeding from the nose or some forms of internal hemorrhage. The dry powder (one quarter teaspoonful) is sometimes useful as an emetic for children in croup or whooping-cough. n. Aromatic spirits of ammonia is a valuable stimulant often recommended in the preceding pages. It is also useful in acid dyspepsia and nerv- ous or sick headache, and simple nervousness. The dose is, for an adult, half a teaspoonful in about a wineglassful of water ; for a child, ten drops, in a teaspoonful of water. This may be given every fifteen minutes until four or five doses have been taken. 12. Calomel is admirable as a dusting powder for chafing or irritation of the skin, and given internally (iV~ J grain every half hour until it acts) is one of the very best means of clearing out and putting in good shape the bowels. 13. Castor oil is a most excellent external appli- cation wherever an oily or greasy preparation is needed. Besides this, it is unquestionably one of the very best remedies for an incipient cold, and generally useful as a purge. For children (and adults, too) it may be made less unpleasant, and in some respects improved in action, by the addition of an equal part of spiced syrup of rhubarb. A mix- ture of these two may be given without much trouble to almost any child. It will be found a little easier to give castor oil, alone or in combination, if it is SUPPLIES FOR EMERGENCIES. 139 warmed, and then given from a cup or spoon that has been heated. 14. Oil of cloves is used chiefly to cure tooth- ache; but a few drops added to a teaspoonful of olive oil and rubbed into the skin will often relieve the pain of neuralgia in various parts of the body. It is also useful in indigestion, in doses of three drops for an adult and one drop for a child. This may be given rubbed up with a little sugar, or in a teaspoonful of sweet oil, or spiced syrup of rhu- barb. 15. Hartshorn is to be used as a stimulant to the heart and to the nervous system. A half teaspoonful may be put into a tumblerful of water and a table- spoonful of the mixture given every few minutes. Its use by inhalation everybody is familiar with. Yet it may be worth while to say that a bottle of hartshorn should never be brought near to a patient's face. The stopper may be wetted and held near the nose, or a few drops may be put on a handkerchief, or the hand, and used in the same way. It is sometimes very comforting to put a few drops on a handkerchief and fan over this toward a person who is very weak. 16. Ipecac. The syrup of ipecac is a fairly good emetic. But it must be used freely. An adult should be given a good tablespoon ful, 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. 140 ACCIDENTS AND EMERGENCIES. It is often usefully employed in cases of poisoning, convulsions, croup, whooping-cough, or asthma. 17. 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 in ftfblish hands it is a dangerous one. There need be, however, no fear of poisoning 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 poison- ing among doctors now than there used to be. It may be considered safe to give thirty 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 — the test being made by shading both eyes, and then bringing a light near them. Persistent con- traction of the pupil ought always to lead to a dis- continuance of any preparation of opium that has been used. To check diarrhoea, a drop of laudanum given every hour will sometimes 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. SUPPLIES FOR EMERGENCIES. 141 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 healing. A similar application is often very sooth- ing in face-ache, tooth-ache, and earache, as well as in the pains of rheumatism and neuralgia. 1 8. Lime-water. Lime water may be prepared at any time by putting a piece of lime as large as a small apple in a quart or two of water and allowing the mixture to stand for a few hours. The clear water may be poured off and bottled for use. In an emergency a piece of lime as large as a walnut may be put in a half pint bottle and the whole well shaken for a minute or two. The water may be strained through a cloth or allowed to clear by settling, according to the degree of haste required. Lime water is used to settle sick stomachs, as an antidote to acid poisons, and in combination with sweet oil as an application to burned surfaces. 19. Mustard. Ground mustard is useful in plas- ters and poultices. In plasters, it should be made weaker by the addition of flour — an equal part or more of the latter, as the plaster is to be stronger or weaker. In adding mustard to poultices, it should be first well mixed with water and then stirred into the poultice mass. Mustard plasters often act quickly and must be re- moved in a few minutes, as soon as the skin is well 142 ACCIDENTS AND EMERGENCIES. reddened. Where it is desired to leave a mustard 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. Further, when mustard plas- ters are applied to persons who are more or less un- conscious, or paralyzed, or of dull intellect, or very young, they must not be left on until the patient shows uneasiness. In such cases the attendant must look at the skin soon and often, to prevent the occurence of blistering.* 20. Nitre. Sweet spirits of nitre is a most useful domestic remedy. A teaspoonful may be added to a tumblerful of water and a tablespoonful of the mix- ture given to an adult, or a dessertspoonful to a child of any age, every hour, in any feverish condition. This will tend to promote healthy activity of the skin and kidneys. 21. Paregoric. Paregoric is an opium preparation which contains, besides opium and other things, some camphor. It is the best preparation for child- *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. Red pepper well diluted with flour 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. SUPPLIES FOR EMERGENCIES. 143 ren, 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 are not too many, and twenty may be given any time after six months. An adult can take a table- spoonful. It may be used internally in all the cases for which laudanum has been recommended. 22. Rhubarb. The spiced syrup of rhubarb is an excellent mild laxative for the bowels. A tea- spoonful 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. The use in combination with castor oil has been described above. 23. Soda. Bicarbonate of soda (baking soda) is useful as an application to burns, as an antidote to acid poisons, and for heartburn. For the latter the dose is as much as will stand on a silver ten-cent piece dissolved in a tablespoonful of water. 24. Turpentine. Spirits, or oil, of turpentine can be used wherever mustard has been recom- mended as an external application. For this pur- pose a soft flannel or muslin cloth should be dipped in turpentine, wrung out nearly dry, laid on the surface, and covered with oiled silk or a few thick- nesses of dry cloth, to prevent evaporation. A milder form of application is what is called a " turpentine stupe." This is prepared by sprinkling 144 ACCIDENTS AND EMERGENCIES. a tablespoonful of turpentine over a flannel cloth ^ folded to several thicknesses) and wrung out of hot water. It is in some respects better to stir the tur- pentine into a pint of hot water, and then to saturate the cloth with it. Turpentine is also useful as an antidote to phos- phorus poisoning. 25. Whisky for medicinal use should be of the best quality. It should always be used in small doses — a teaspoonful for an adult — in hot water, fre- quently repeated. HOW TO MAKE POULTICES. Poultices. The commonest materials for poul- tices are hops, bread, flaxseed, and corn-meal. A hop poultice is made by pouring hot water upon hops until 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 have a vessel con- taining hot water and to pour into it flaxseed meal or corn-meal, constantly stirring, until the mixture is as thick as porridge, almost (but not quite) soft enough to run. Poultices should be spread about half an inch thick. To spread a poultice, a piece of fine old muslin (or a piece of open-meshed stuff, such as ordinary cheese-cloth), twice as long as the poultice is to be, is laid on a flat surface, and one-half of it SUPPLIES FOR EMERGENCIES. 145 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 Vpe re- moved, 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 upon 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 to 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 a folded towel. 146 ACCIDENTS AND EMERGENCIES. Signs of Death. In the absence of a physician it sometimes be- comes important that others shall be able to deter- mine whether death has taken place or not. The occurrence of death can be recognized by the follow- ing 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 for 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 SIGNS OF DEATH. 147 not 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 are slack enough to 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 movement of the heart by sounds made by its valves, which, when perfect, sound like the sylla- bles " ub-dup, " "ub-dup," and so on. If on care- ful listening the heart sounds cannot be heard, and the cold metal fails to show any evidence of breath- ing, 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 then rigidity come on, it hardly requires the notes 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 cer- tainty between life and death. Within two or three 148 ACCIDENTS AND EMERGENCIES. hours after the stopping of the heart the whole of the 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 watching have been used to detect the slight- est evidence of life, and in not a single case has a mistake been found to have been made. The author has for years investigated cases in which it has been reported in the newspapers that persons had been buried alive ; and in every case in which he could get any information from a trust- worthy source the story has been found to be absolutely false. NDEX. PAGE ABDOMEN, contusion 61 wounds 63 Absorbent cotton 133 Accidents, railroad and machinery 72 Acetate of lead 102 Acid antidotes 109 carbolic 100 muriatic 98 nitric 98 oxalic 99 prussic 100 sulphuric 98 Acids, burns with 43 Aconite 105 Aconitum napellus 116 uncinatum .....118 Adhesive plaster..... 63, 136 ^Ethusa no Alcohol, poisoning 106 Alkalies, burns with 43 poisoning with 100 Alkaline antidotes 109 Alum 137 Ammonia 139 poisoning with 100 aromatic 138 Ankle, sprains 50 Antidotes, acid 109 alkaline 109 Aorta. 14, 78, 79 Apoplexy 27, 29 treatment 37 Arm, crushed 75 fractures of 54 hemorrhage from 84, 86 wounds 84 Aromatic spirits of ammonia 138 Arrow wounds 65 Arsenic 101 PAGE Arteries, description 78-82 hemorrhage from 83 below elbow 85 of arm 84, 86 finger 85 foot.... 87 forearm... 85 hand 85 leg..... .... 87 neck 84 scalp 88 thigh 88 Artificial respiration 13 Asthma 125 Atropa belladonna no Atropia poisoning... 104 DANDAGES 133 •*-' how to apply..i34~i36 how to fasten 135 Belladonna, description of no poisoning 104 Bites of cats and dogs 69 Bitter-sweet no Black-drop 103 Bland liquids 109 Bleeding. (See Hemorrhage.) Body, crushed 75 large splinters in 67 Bones, broken. (See Fractures.) Bowels, escaping 63 hemorrhage from 92 Brain, compression 40 concussion 40 disorders 27 injuries 40 Broken bones. (See Fractures.) Bruises 61 Burns 4 I_ 4 2 149 150 INDEX. PAGE Burns, pain in 42 with acids 43 alkalies 43 pitch 44 sun 44 pALOMEL, uses of 138 ^ Capillary hemorrhage 82 Carbolic acid 100 Carbonic acid 17 Carotid arteries 78 Carron oil 42 Castor oil 138 Cat bites 69 Catalepsy 138 Caustic alkalies, burns with 43 lunar 103 Centipede stings 68 Charcoal fumes 117 Chest, contusions 61 crushed 75 wounds 64 Chilblain. (See Frost-bite.) Chloral 28 poisoning 104 Chlorodyne poisoning 103 Choking 17 Cholera morbus 119 Circulation, description 78-82 disorders 27 Cleansing wounds 64-89 Clots, not to be disturbed 84 Cloves, oil 139 Cold, effects 47 - 4§ Colic ... 120 Collar-bone, fractures 58 Compound fractures 59 Compression of brain 40 Concussion of brain 40 Conium 112 Contused wounds 62 Contusions 61 of abdomen 61 chest 61 Convulsions, diagnosis 27-30 in children 36 treatment 36, 128 Coroner, duties 112 Corrosive sublimate 102 Cotton absorbent 103 Cough, whooping 124 Cow-bane 112 Creasote 100 Croton oil 102 dose of laudanum 109 PAGE Croup 123 Crushed feet, fingers, hands, toes.. 74 arm, body, chest, legs 75 Cuts (See Wounds, incised.) 62 P^EADLY nightshade 105 *-' Death, signs of. 14, 146 Decayed meats.. ic6 vegetables 106 Depression, treatment 74, 75, 98 (See Shock.) 75 Diarrhoea 121 Digitalis in Dislocations 51-53 offinger 51 jaw 51 shoulder 52 Disorders of brain 27 circulation 27 Dog-bites 69, 70 not to be cauterized 69 Domestic emergencies 119 Drowning 12 Drunkenness. (See Intoxication.) Dwarf-yew .. 111 Dysentery 122 CAR, cut off 63 *-* foreign bodies in 24 insects in 25 syringing 24 Earache 126 Emergencies, domestic 119 supplies for 130-144 Emergency case 130 use of 133 Epilepsy, diagnosis .27-29, 35 treatment 35 Epileptic fits. (See Epilepsy.) Eye, foreign bodies in 21 lime in 21 pupils 29 splinters in 67 Eyelid, everting 21 PAINTING 27 * stops hemorrhage 84, 89 treatment 33 Fever 128 Finger, crushed 74 cutoff 63 dislocation 51 fracture 55 hemorrhage from 85 torn off 74 INDEX. 151 PAGE Finger wounds 85 Fish-hook wounds 66 Fits 33-39 epileptic 27, 35 Fool's parsley no Foot, crushed 74 hemorrhage from 87 needles, etc. in 65 torn off 75 Fore-arm, fractures 55 hemorrhage from 85 Foreign bodies in ear 21, 24 eye 21 nose 21, 23 throat 18 wind-pipe 17, 19 swallowed 19 Fowler's solution, poisoning with..ioi Foxglove, description in Fractures 54~6o of arm 54 collarbone 58 deep-seated bones 57 finger 55 fore-arm 55 hip-bone 57 jaw 59 knee-pan 56 leg 57 ribs 58 shoulder-blade 57 skull 59 spinal column 59 thighbone 57 compound 59 near joint 57 swelling after 60 Freezing 47 Frost-bite .- 47 Frozen parts, treatment 47 GAS, carbonic acid 17 illuminating 17 Gases, noxious 17 poisoning with, detection... 28 Glass, splinter 67 Ground hemlock in Gullet (choking) 18 Gunshot wounds 71 l_J AND, crushed 74 *■ *■ fish-hookin 66 hemorrhage from 85 needles, etc. in 65 torn off 75 PAGE Hanging 16 Hartshorn 139 poisoning with 100 Head. (See Brain and Scalp.) Heat, effects 41-46 exhaustion 45 how to apply 76 stroke 44 Hellebore, description 117 Hemlock, poisoning with 105 ground 111 poison 112 water 112 Hemorrhage 78-92 after accidents 73 capillary 8* from arm 84-86 arteries 83 boweis 92 fingers 85 foot 87 forearm 85 hand 85 jugular vein 83 leg 87 lungs 91 neck 84 nose 91 scalp 88 stomach 92 thigh 88 tooth-socket 91 veins 82 internal 92 special 91-92 stopped by fainting... 84 treatment, recapitu- lation 89 Henbane 113 Hydrophobia 69 Hyoscyamus 113 Hysterics, diagnosis 30 treatment , 34 ILLUMINATING gas, poison- * ing 17 Incised wounds 62 Indian poke 117 tobacco 105, 114 turnip 115 Injured, transportation. 93-96 Insects, in ear 25 stings 68 Insensibility 26-32 Internal hemorrhage 92 152 INDEX. PAGE Intoxication . 28 caution in 31 diagnosis 29 treatment 38 Iodine 103 Ipecac. 139 Ivy, ppison, description 116 treatment 127 TACK-IN-THE-PULPIT 115 ^ Jamestown weed 115 poisoning with. .105 Jaw, dislocation 51 fracture 59 Jimson weed. (See Jamestown Weed.) Joints, dislocation 51 fracture near 59 JZIDNEYS, disease of 28 1*- Knee-pan, fractures 56 T ACERATED wounds 64-73 *-" Lacerations 64-73 Laudanum, dose 109 poisoning 103 uses 23, 140 Lead, sugar of 102 Leg, crushed 75 fracture 57 hemorrhage from 87 Lightning-stroke 46 Lime, in eye 23 Lime-water 141 how to make 42, 98 Liquids, bland 109 Litters 93 Lobelia 114 Lung, escape 64 hemorrhage from 91 Luxation. (See Dislocation.) Lye, poisoning 100 MACHINERY accidents 72 Mad-dog bites 70 Meats, decayed 106 Mercury bichloride 102 Monkshood 116 poisoning 105 Morphine, poisoning... 103 Muriatic acid 98 Mustard 141 plasters 141 NAIL, splinters under 66 Nails, wounds with 65 PAGE Nausea 120 Neck, wounds 84 Needles, wounds with 65 Nervous attacks 125 Neuralgia 127 Nightshade, deadly no woody no poisoning 105 Nitrate of silver, poisoning 103 Nitre, sweet spirits 142 Nitric acid 98 Nose, bleeding from 91 cut off. 63 foreign bodies in 21, 23 Noxious gases and vapors 17 OAK, poison. (See Ivy, poison.) Obstructions to respiration... 12 Oil, carron 42 castor 138 cloves 139 croton 102, 109 vitriol 98 Opium poisoning 28 treatment of 103 DARALYSIS 30 *■ Paregoric 142 poisoning 103 Paris green, poisoning 101 Parsley, fool's no Parsnip, wild 118 Pepper, red 142 Phosphorus poisoning 102 Phytolacca 116 Pin wounds 65 Pitch, burns with 44 Plants, poisonous 110-118 Plaster, adhesive 63, 136 mustard 141 Poison hemlock 112 ivy (oak, vine) 116, 127 sumac 105, 116 Poisoned wounds 68 Poisoning, recapitulation of treat- ment 106, 107 unconsciousness due to 28 Poisons 97-118 acid 98-100 alkaline 100 recapitulation of treat- ment 106 unknown 97 Poisonous plants 110-118 Poke-berry 116 INDEX. 153 PAGE Poke-root 117 Potash, poisoning 100 Poultices, how to make 144 Prussic acid, poisoning 100 Punctured wounds 65 RAILROAD accidents 72 Respiration, artificial 13 obstructions to... 12 Rhubarb 143 Rhus toxicodendron 116 venenata 116 Ribs, fracture 58 CCALDS 4i-43 ^ pain in 42 Scalp wounds 88 hair to close 63 Scorpion stings 68 Seizures 33 Serpent bites 68 Sewing up wounds 63 Shock 75 Shoulder, dislocation 52 Signs of death 14, 146 Silver, nitrate of. 103 Skull, fracture 59 Snakebites 68 Soda 143 poisoning with 100 Spanish windlass 87 Spider stings 68 Spinal column, fracture 59 Splinters 66 in body 67 eye 67 of glass 67 under nail 66 Splints 60 Spotted cow-bane 112 Sprains < 49 of ankle 50 wrist 49 Sticking plaster 63 Stimulation 15, 76 Stimulants 109 Stings 68 Stitching wounds 63 Stomach, hemorrhage from 92 Stramonium 115 Strangulation 16 Stretchers 93 Strychnine 104 Stupes.. 143 Sublimate, corrosive 102 K PAGE Suffocation 17 Sugar of lead 102 Sulphuric acid 98 Sumac 105, 116 Sunburn 44 Sunstroke 39, 44 Supplies for emergencies 130-144 Syrup of rhubarb 143 TACK wounds 65 Tarantula stings 68 Tartar emetic 102 Tears 73 Temperature of skin 30 Thigh, hemorrhage from 88 wounds 88 Thigh-bone, fractures 56 Thorn-apple 115 Thorns, wounds with 66 Throat, wounds 64 Toadstools 105 Tobacco 105 Indian 105, 114 Toes, crushed 74 cutoff 63 torn off 74 Tooth, bleeding after extraction... 91 Toothache 126 Transportation of injured 93~96 Turnip, Indian 115 Turpentine 143 stupe 143 UNCONSCIOUSNESS ... 26-32 causes 27 examination in... 29 treatment 21 VAPORS, noxious 17 Varicose veins 82 Vegetables, decayed 106 Veins 80 hemorrhage from 82 varicose 82 Veratrum poisoning 105 album 117 viride 117 Virginia creeper 116 Vitriol, oil of. 98 Vomiting 120 how to provoke 108 WATER hemlock 112 Weed, Jamestown (Jimson).ii5 Whisky, dose 144 154 INDEX. PAGE Whooping-cough 124 Wild parsnip 118 Windlass, Spanish 87 Windpipe, foreign bodies in 17 Wolf's-bane 118 Woody nightshade no Wounds 61-71 cleansing of. 64 stitching of 63 contused 62 gunshot 71 incised 62 lacerated 64-73 poisoned 68 punctured 65 of abdomen 63 arm 84, 86 chest 64 fingers 85 PAGE Wounds of foot 87 forearm 85 hand 85 leg 87 neck 84 scalp 88 thigh 88 throat 64 with arrow 65 glass 67 nail 65 needle 65 tack 65 Pin 65 thorn 66 Wrist, sprains of 49 VEW, dwarf m CATALOGUE No. 7. SEPTEMBER, 1892. A CATALOGUE OF Books for Students. INCLUDING THE ? QUIZ-COMPENDS ? CONTENTS. PAGE New Series of Manuals, 2,3,4,5 Anatomy, Biology, Chemistry, . Children's Diseases, Dentistry, Dictionaries, Eye Diseases, Electricity, . Gynaecology, Hygiene, Materia Medica Medical Jurisprudence, Nervous Diseases, PAGE Obstetrics 10 Pathology, Histology, . . 11 Pharmacy, . . . .12 Physical Diagnosis, . . n Physiology, . . . .11 Practice of Medicine, . 11, 12 Prescription Books, . . 12 ?Quiz-Compends ? . Skin Diseases, Surgery and Bandaging, Therapeutics, Urine and Urinary Organs, Venereal Diseases, 14, 15 PUBLISHED BY P. BLAKISTON, SON & CO., Medical Booksellers, Importers and Publishers. LARGE STOCK OF ALL STUDENTS' BOOKS, AT THE LOWEST PRICES. 1012 Walnut Street, Philadelphia. *** For sale by all Booksellers, or any book will be sent by mail, postpaid, upon receipt of price. Catalogues of books on all branches of Medicine, Dentistry, Pharmacy, etc., supplied upon application. p/i£?xo C ceifts } 3 °°° Q uestions on Medical Subjects. " An excellent Series of Manuals." — Archives of Gynecology. A NEW SERIES OF STUDENTS' MANUALS On the various Branches of Medicine and Surgery. Can be used by Students of any College. Price of each, Handsome Cloth, $3.00. Full Leather, $3.50 The object of this series is to furnish good manuals for the medical student, that will strike the medium between the compend on one hand and the prolix text- book on the other — to contain all that is necessary for the student, without embarrassing him with a flood of theory and involved statements. They have been pre- pared by well-known men, who have had large experience as teachers and writers, and who are, therefore, well informed as to the needs of the student. Their mechanical execution is of the best — good type and paper, handsomely illustrated whenever illustrations are of use, and strongly bound in uniform style. Each book is sold separately at a remarkably low price, and the immediate success of several of the volumes shows that the series has met with popular favor. No. 1. SURGERY. 318 Illustrations. Third Edition. A Manual of the Practice of Surgery. By Wm. J. Walsham, m.d., Asst. 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It is issued in a neat and attractive form, and at a very reasonable price." — Boston Medical and Surgical Journal . No. 3. OBSTETRICS. 227 Illustrations. A Manual of Midwifery. By Alfred Lewis Galabin, M.A., M.D., Obstetric Physician and Lecturer on Mid- wifery and the Diseases of Women at Guy's Hospital, London; Examiner in Midwifery to the Conjoint Examining Board of England, etc. With 227 Illus. "This manual is one we can strongly recommend to all who desire to study the science as well as the practice of midwifery. Students at the present time not only are expected to know the principles of diagnosis, and the treatment of the various emergen- cies and complications that occur in the practice of midwifery, but find that the tendency is for examiners to ask more questions relating to the science of the subject than was the custom a few years ago. * * * The general standard of the manual is high ; and wherever the science and practice of midwifery are well taught it will be regarded as one of the most important text-books on the subject." — London Practitioner . No. 4. PHYSIOLOGY. Fifth Edition. 321 ILLUSTRATIONS AND A GLOSSARY. A Manual of Physiology. By Gerald F. Yeo, m.d., f.r.cs., Professor of Physiology in King's College, London. 321 Illustrations and a Glossary of Terms. Fifth American from last English Edition, revised and improved. 758 pages. This volume was specially prepared to furnish students with a new text-book of Physiology, elementary so far as to avoid theories which have not borne the test of time and such details of methods as are unnecessary for students in our medical colleges. "The brief examination I have given it was so favorable that I placed it in the list of text-books recommended in the circular of the University Medical College." — Prof. Lewis A. Stimson, m.d., 57 East 33d Street, Neiv York. Price of each Book, Cioth, $3.00; Leather, $3.50. THE NEW SERIES OF MANUALS. No. 5. DISEASES OP CHILDREN. SECOND EDITION. A Manual. By J. F. Goodhart, m.d., Phys. to the Evelina Hospital for Children ; Asst. Phys. to Guy's Hospital, London. Second American Edition. Edited and Rearranged by Louis Starr, m.d., Clinical Prof, of Dis. of Children in the Hospital of the Univ. of Pennsylvania, and Physician to the Children's Hos- pital, Phila. Containing many new Prescriptions, a list of over 50 Formulae, conforming to the U. S. Pharma- copoeia, and Directions for making Artificial Human Milk, for the Artificial Digestion of Milk, etc. Illus. " The author has avoided the not uncommon error of writing a book on general medicine and labeling it * Diseases of Children/ but has steadily kept in view the diseases which seemed to be incidental to childhood, or such points in disease as appear to be so peculiar to or pronounced in children as to justify insistence upon them. * * * A safe and reliable guide, and in many ways admirably adapted to the wants of the student and practitioner." — American Journal of Medical Science. No. 6. MATERIA MEDICA, PHARMACY, PHARMACOLOGY, AND THE- RAPEUTICS. JUST READY. A Handbook for Students. By Wm. Hale White, M.D., F.R.G.P., etc., Physician to, and Lecturer on Ma- teria Medica, Guy's Hospital; Examiner in Materia Medica, Royal College of Physicians, London, etc. American Edition. Revised by Reynold W. Wilcox, m.a., m.d., Prof, of Clinical Medicine at the New York Post-Graduate Medical School and Hospital ; Assistant Visiting Physician Bellevue Hospital. 580 pages. In preparing this book, the wants of the medical student of to-day have been constantly kept in view. The division into several sub- jects, which are all arranged in a systematic, practical manner, will be found of great help in mastering the whole. The work of the editor has been mainly in the line of adapting the book to the use of American students ; at the same time, however, he has added much new material. Dr. Wilcox's long experience in teaching and writing on therapeutical subjects particularly fits him for the position of editor, and the double authorship has resulted in mak- ing a very complete handbook, containing much minor useful in- formation that if prepared by one man might have been overlooked. Price of each Book, Cloth, $3.00 ; Leather, $3.50. THE NEW SERIES OF MANUALS. No. 7. MEDICAL JURISPRUDENCE AND TOXICOLOGY. THIRD REVISED EDITION. By John J. Reese, m.d., Professor of Medical Jurispru- dence and Toxicology in the University of Pennsyl- vania ; President of the Medical Jurisprudence Society of Phila. ; Third Edition, Revised and Enlarged. " This admirable text-book." — Amer.Jour. of Med. Sciences. u We lay this volume aside, after a careful perusal of its pages, with the profound impression that it should be in the hands of every doctor and lawyer. It fully meets the wants of all students He has succeeded in admirably condensing into a handy volume all the essential points." — Cincinnati Lancet and Clinic, " The book before us will, we think, be found to answer the ex- pectations of the student or practitioner seeking a manual of juris- prudence, and the call for a second edition is a flattering testimony to the value of the author's present effort. The medical portion of this volume seems to be uniformly excellent, leaving little for adverse criticism. 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A new Text-book for Students and Practitioners, Systematic and Topo- graphical, including the Embryology, Histology, and Morphology of Man. With special reference to the requirements of Practical Surgery and Medicine. With 816 Illustrations, 400 of which are original. Octavo. Cloth, 7.50; Leather, 8.50 Ballou's Veterinary Anatomy and Physiology. Illustrated. By Wm. R. Ballou, m.d., Professor of Equine Anatomy at New York College of Veterinary Surgeons. 29 graphic Illustrations. i2mo. Cloth, 1. 00; Interleaved for notes, 1. «5 Holden's Anatomy. A manual of Dissection of the Human Body. Fifth Edition. Enlarged, with Marginal References and over 200 Illustrations. Octavo. Bound in Oilcloth, for the Dissecting Room, $4.50. Holden's Human Osteology. Comprising a Description of the Bones, with Colored Delineations of the Attachments of the Muscles. The General and Microscopical Structure of Bone and its Development. With Lithographic Plates and Numerous Illus- trations. Seventh Edition. 8vo. Cloth, 6.00 Holden's Landmarks, Medical and Surgical. 4th ed. Clo., 1.25 Potter's Compend of Anatomy. Fifth Edition. Enlarged. 16 Lithographic Plates. 117 Illustrations. See Page 14. Cloth, 1. 00; Interleaved for Notes, 1.25 CHEMISTRY. Bartley's Medical Chemistry. Second Edition. A text-book prepared specially for Medical, Pharmaceutical, and Dental Stu- dents. With 50 Illustrations, Plate of Absorption Spectra and Glossary of Chemical Terms. Revised and Enlarged. Cloth, 2 . 50 Trimble. Practical and Analytical Chemistry. A Course in Chemical Analysis, by Henry Trimble, Prof, of Analytical Chem- istry in the Phila. College of Pharmacy. Illustrated. Fourth Edition, Enlarged. 8vo. Cloth, 1.50 Bloxam's Chemistry, Inorganic and Organic, with Experiments. Seventh Edition. 281 Illustrations. Cloth, 4.50; Leather, 5.50 J^* See pages 2 to 5 for list 0/ Students' Manuals . STUDENTS' TEXT-BOOKS AND MANUALS. 7 Chemistry : — Continued. Richter's Inorganic Chemistry. 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The Urine, Common Poisons, and Milk Analysis, Chemical and Microscopical. For Laboratory Use. Fourth Edition, Enlarged. Illustrated. Cloth, 1.00 Van Niiys. Urine Analysis. Illus. Cloth, 2.00 CHILDREN. Goodhart and Starr. The Diseases of Children. Second Edition. By J. F. Goodhart, m.d., Physician to the Evelina Hospital for Children ; Assistant Physician to Guy's Hospital, London. Revised and Edited by Louis Starr, m.d., Clinical Professor of Diseases of Children in the Hospital of the Univer- sity of Pennsylvania; Physician to the Children's Hospital, Philadelphia. Containing many Prescriptions and Formulae, conforming to the U. S. Pharmacopoeia, Directions for making Artificial Human Milk, for the Artificial Digestion of Milk, etc. Illustrated. Cloth, 3.00; Leather, 3.50 Hatfield. Diseases of Children. By M. P. Hatfield, m.d., Professor of Diseases of Children, Chicago Medical College. Colored Plate. i2mo. Cloth, 1.00; Interleaved, 1.25 Starr. Diseases of the Digestive Organs in Infancy and Childhood. With chapters on the Investigation of Disease, and on the General Management of Children. By Louis Starr, m.d., Clinical Professor of Diseases of Children in the Univer- sity of Pennsylvania. Illus. Second Edition. Cloth, 2.25 4$~ See pages 14 and IS for list of ? Quiz- Comp ends? 8 STUDENTS' TEXT-BOOKS AND MANUALS. DENTISTRY. Fillebrown. Operative Dentistry. 330 Illus. Cloth, 2.50 Flagg's Plastics and Plastic Filling. 4th Ed. Cloth, 4.00 Gorgas. Dental Medicine. Fourth Edition. Cloth, 3.50 Harris. Principles and Practice of Dentistry. Including Anatomy, Physiology, Pathology, Therapeutics, Dental Surgery and Mechanism. Twelfth Edition. Revised and enlarged by Professor Gorgas. 1028 Illustrations. Cloth, 7.00 ; Leather, 8.00 Richardson's Mechanical Dentistry. Fifth Edition. 569 Illustrations. 8vo. Cloth, 4.50; Leather, 5.50 Sewill. Dental Surgery. 200 Illustrations. 3d Ed. Clo., 3.00 Taft's Operative Dentistry. 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Cloth, red edges .75 ; pocket-book style, 1.00 Longley's Pocket Dictionary. The Student's Medical Lexicon, giving Definition and Pronunciation , with an Appendix giving Abbreviations used in Prescriptions, Metric Scale of Doses, etc. 24mo. Cloth, 1. 00; pocket-book style, 1.25 EYE. Hartridge on Refraction. 5th Edition. Illus. Cloth, 2.00 Swanzy. Diseases of the Eye and their Treatment. 176 Illustrations. Fourth Edition. Cloth, 300; Leather, 3.50 Fox and Gould. Compend of Diseases of the Eye and Refraction. 2d Ed. Enlarged. 71 Illus. 39 Formulae. Cloth, 1. 00 ; Interleaved for Notes, 1.25 f^ See pages 2 to 5 for list of Students' Manuals. STUDENTS' TEXT-BOOKS AND MANUALS. 9 ELECTRICITY. Bigelow. Plain Talks on Medical Electricity. Cloth, i.oo Mason's Compend of Medical Electricity. Cloth, i.oo Steavenson and Jones. Medical Electricity. A Practical Handbook. Just Ready. Illustrated. i2mo. Cloth, 2.50 HYGIENE. Coplin and Bevan. Practical Hygiene. By W. M. L. 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Handbook of Materia Medica, Pharmacy, and Therapeutics. Including Action of Medicines, Special Thera- peutics, Pharmacology, etc. By Saml. O. L. Potter, m.d., m.r.c.p. (Lond.), Professor of the Practice of Medicine in Cooper Medical College, San Francisco. Third Revised and Enlarged Edition. 8vo. Cloth, 4.00; Leather, 5.00 White and Wilcox. Materia Medica, Pharmacy, Phar- macology, and Therapeutics. A Handbook for Students. By Wm. Hale White, m.d., f.r.c.p., etc., Physician to and Lecturer on Materia Medica, Guy's Hospital. Revised by Reynold W. Wilcox, m.d., Professor of Clinical Medicine at the New York Post Graduate Medical School, Assistant Physician Bellevue Hospital, etc. American Edition. Clo., 3.00; Lea., 3.50 4^* See pages 14 and rj for list of f Quiz-Cotnpends ? 10 STUDENTS' TEXT-BOOKS AND MANUALS. MEDICAL JURISPRUDENCE. Reese. A Text-book of Medical Jurisprudence and Toxi- cology. By John J. Reese, m.d., Professor of Medical Juris- prudence and Toxicology in the Medical Department of the University of Pennsylvania ; Physician to St. Joseph's Hospital. Third Edition. Cloth, 3.00; Leather, 3.50 NERVOUS DISEASES. Gowers. Manual of Diseases of the Nervous System. A Complete Text-book. By William R. Gowers, m.d., Prof. Clinical Medicine, University College, London. Physician to National Hospital for the Paralyzed and Epileptic. Second Edition. Revised, Enlarged, and in many parts Rewritten. With many new Illustrations, Octavo. Vol. I. Diseases of the Nerves and Spinal Cord. 616 pages. Cloth, 3.50 Vol. II. Diseases of the Brain and Cranial Nerves. General and Functional Diseases. Nearly Ready. Ormerod. Diseases of Nervous System. Student's Guide to. By J. A. Ormerod, m.d., Oxon., f.r.c.p. (London), Member Path- ological, Clinical, Ophthalmological, and Neurological Societies, Physician to National Hospital for Paralyzed and Epileptic and to City of London Hospital for Diseases of the Chest, Demon- strator of Morbid Anatomy, St. Bartholomew's Hospital, etc. With 75 Wood Engravings. Cloth, 2.00 OBSTETRICS AND GYNAECOLOGY. Davis. A Manual of Obstetrics. By Edw. P. Davis, Dem- onstrator of Obstetrics, Jefferson Medical College, Philadelphia. Colored Plates, and 130 other Illustrations. i2mo. Cloth, 2.00 Byford. Diseases of Women. The Practice of Medicine and Surgery, as applied to the Diseases and Accidents Incident to Women. By W. H. Byford, a.m., m.d., Professor of Gynaecology in Rush Medical College and of Obstetrics in the Woman's Med- ical College, etc., and Henry T. Byford, m.d., Surgeon to the Woman's Hospital of Chicago. Fourth Edition. Revised and Enlarged. 306 Illustrations, over 100 of which are original. Octavo. 832 pages. Cloth, 5.00 ; Leather, 6.00 Lewers' Diseases of Women. A Practical Text-book. 139 Illustrations. Second Edition. Cloth, 2.50 Parvin's Winckel's Diseases of Women. Second Edition. Including a Section on Diseases of the Bladder and Urethra. 150 Illus. Revised. See page 3. Cloth, 3.00; Leather, 3.50 Morris. Compend of Gynaecology. Illustrated. Cloth, 1.00 WinckePs Obstetrics. A Text-book on Midwifery, includ- ing the Diseases of Childbed. By Dr. F. Winckel, Professor of Gynaecology, and Director of the Royal University Clinic for Women, in Munich. Authorized Translation, by J. Clifton Edgar, m.d., Lecturer on Obstetrics, University Medical Col- lege, New York, with nearly 200 handsome Illustrations, the majority of which are original. 8vo. Cloth, 6.00; Leather, 7.00 4^~ See pages 2 to 5 for list of New Manuals. STUDENTS' TEXT-BOOKS AND MANUALS. 11 Obstetrics and Gynecology : — Continued. Landis' Compend of Obstetrics. Illustrated. 4th Edition, Enlarged. Cloth, 1.00; Interleaved for Notes, 1.25 Galabin's Midwifery. By A. Lewis Galabin, m.d., f.r.c.p. 227 Illustrations. Seepages. Cloth, 3.00; Leather, 3.50 PATHOLOGY, HISTOLOGY, ETC. Wethered. Medical Microscopy. By Frank J. Wethered, m.d., m.r.c.p. 98 Illustrations. Cloth, 2.50 Bowlby. Surgical Pathology and Morbid Anatomy, for Students. 135 Illustrations. i2mo. Cloth, 2.00 Gilliam's Essentials of Pathology. A Handbook for Students. 47 Illustrations. i2mo. Cloth, 2.00 Virchow's Post-Mortem Examinations. 3d Ed. Cloth, 1.00 PHYSICAL DIAGNOSIS. Fenwick. Student's Guide to Physical Diagnosis. 7th Edition. 117 Illustrations. i2mo. Cloth, 2.25 Tyson's Student's Handbook of Physical Diagnosis. Illus- trated. i2mo. Cloth, 1.25 PHYSIOLOGY. Yeo's Physiology. Fifth Edition. The most Popular Stu- dents' Book. By Gerald F. Yeo, m.d., f.r.c.s., Professor of Physiology in King's College, London. Small Octavo. 758 pages. 321 carefully printed Illustrations. With a Full Glossary and Index. See page 3. Cloth, 3.00; Leather, 3.50 Brubaker's Compend of Physiology. Illustrated. Sixth Edition. Cloth, 1. 00; Interleaved for Notes, 1.25 Kirke's Physiology. New 13th Ed. Thoroughly Revised and Enlarged. 502 Illustrations, some of which are printed in colors. Cloth, 4.00 ; Leather, 5.00 Landois' Human Physiology. Including Histology and Micro- scopical Anatomy, and with special reference to Practical Medi- cine. Fourth Edition. Translated and Edited by Prof. Stirling. 845 Illustrations. Cloth, 7.00 ; Leather, 8.00 M With this Text-book at his command, no student could fail in his examination." — Lancet. Sanderson's Physiological Laboratory. Being Practical Ex- ercises for the Student. 350 Illustrations. 8vo. Cloth, 5.00 PRACTICE. Taylor. Practice of Medicine. A Manual. By Frederick Taylor, m.d., Physician to, and Lecturer on Medicine at, Guy's Hospital, London ; Physician to Evelina Hospital for Sick Chil- dren, and Examiner in Materia Medica and Pharmaceutical Chemistry, University of London. Cloth, 2.00; Leather, 2.50 J9&~ See pages 14 and 15 for list of ? Quiz- Comp ends t 12 STUDENTS' TEXT-BOOKS AND MANUALS. Practice : — Continued. Roberts' Practice. New .Revised Edition. A Handbook of the Theory and Practice of Medicine. By Frederick T. Roberts, m.d., m.r.c.p., Professor of Clinical Medicine and Therapeutics in University College Hospital, London. Seventh Edition. Octavo. Cloth, 5.50 ; Sheep, 6.50 Hughes. Compend of the Practice of Medicine. 4th Edi- tion. Two parts, each, Cloth, 1.00; Interleaved for Notes, 1.25 Part i. — Continued, Eruptive and Periodical Fevers, Diseases of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, Kidneys, etc., and General Diseases, etc. Part ii. — Diseases of the Respiratory System, Circulatory System, and Nervous System; Diseases of the Blood, etc. Physicians' Edition. Fourth Edition. Including a Section on Skin Diseases. With Index. 1 vol. Full Morocco, Gilt, 2.50 From. John A. Robinson, M.D., Assistant to Chair of Clinical Medicine, now Lecturer on Materia Medica, Rush Medical Col- lege, Chicago. "Meets with my hearty approbation as a substitute for the ordinary note books almost universally used by medical students. It is concise, accurate, well arranged, and lucid, . . . just the thing for students to use while studying physical diagnosis and the more practical departments of medicine." PRESCRIPTION BOOKS. Wythe's Dose and Symptom Book. Containing the Doses and Uses of all the principal Articles of the Materia Medica, etc. Seventeenth Edition. Completely Revised and Rewritten. Just Ready. 321110. Cloth, 1. 00; Pocket-book style, 1.25 Pereira's Physician's Prescription Book. Containing Lists of Terms, Phrases, Contractions, and Abbreviations used in Prescriptions, Explanatory Notes, Grammatical Construction of Prescriptions, etc., etc. By Professor Jonathan Pereira, m.d. Sixteenth Edition. 321110. Cloth, 1. 00; Pocket-book style, 1.25 PHARMACY. Stewart's Compend of Pharmacy. Based upon Remington's Text-book of Pharmacy. Third Edition, Revised. With new Tables, Index, Etc. Cloth, 1.00 ; Interleaved for Notes, 1.25 Robinson. Latin Grammar of Pharmacy and Medicine. By H. D. Robinson, ph.d., Professor of Latin Language and Literature, University of Kansas, Lawrence. With an Intro- duction by L. E. Sayre, ph.g., Professor of Pharmacy in, and Dean of, the Dept. of Pharmacy, University of Kansas. i2mo. Cloth, 2.00 SKIN DISEASES. Anderson, (McCall) Skin Diseases. A complete Text-book, with Colored Plates and numerous Wood Engravings. 8vo. Cloth, 4.50; Leather, 5.50 Van Harlingen on Skin Diseases. A Handbook of the Dis- eases of the Skin, their Diagnosis and Treatment (arranged alpha- betically). By Arthur Van Harlingen, m.d., Clinical Lecturer on Dermatology, Jefferson Medical College; Prof, of Diseases of the Skin in the Philadelphia Polyclinic. 2d Edition. Enlarged. With colored and other plates and illustrations. i2mo. Cloth, 2.50 4^* See pages 2 to 5 for list of Neiv Manuals. STUDENTS' TEXT-BOOKS AND MANUALS. 13 SURGERY AND BANDAGING. Moullin's Surgery. 500 Illustrations (some colored), 200 of which are original. Cloth, net 7.00; Leather, net 8.00 Jacobson. Operations in Surgery. A Systematic Handbook for Physicians, Students, and Hospital Surgeons. By W. H. A. Jacobson, b.a. Oxon., f.r.c.s. Eng. ; Ass't Surgeon Guy's Hos- pital ; Surgeon at Royal Hospital for Children and Women, etc. 199 Illustrations. 1006 pages. 8vo. Cloth. 5.00; Leather, 6.00 Heath's Minor Surgery, and Bandaging. Ninth Edition. 142 Illustrations. 60 Formulae and Diet Lists. Cloth, 2.00 Horwitz's Compend of Surgery, Minor Surgery and Bandaging, Amputations, Fractures, Dislocations, Surgical Diseases, and the Latest Antiseptic Rules, etc., with Differential Diagnosis and Treatment. By Orville Hokwitz, b.s., m.d., Demonstrator of Surgery, Jefferson Medical College. 4th edition. Enlarged and Rearranged. 136 Illustrations and 84 Formulae. i2mo. Cloth, 1. 00 ; Interleaved for the addition of Notes, 1.25 *^.*The new Section on Bandaging and Surgical Dressings con- sists of 32 Pages and 41 Illustrations. Every Bandage of any importance is figured. This, with the Section on Ligation of Arteries, forms an ample Text-book for the Surgical Laboratory. Walsham. Manual of Practical Surgery. Third Edition. By Wm. J. Walsham, m.d., f.r.c.s., Asst. Surg, to, and Dem- of Practical Surg, in, St. Bartholomew's Hospital; Surgeon to Metropolitan Free Hospital, London. With 318 Engravings. See page 2. Cloth, 3.00; Leather, 3.50 URINE, URINARY ORGANS, ETC. Holland. The Urine, and Common Poisons and The Milk. Chemical and Microscopical, for Laboratory Use. Illus- trated. Fourth Edition. i2mo. Interleaved. Cloth, 1.00 Ralfe. Kidney Diseases and Urinary Derangements. 42 Illus- trations. i2mo. 572 pages. Cloth, 2.75 Marshall and Smith. On the Urine. The Chemical Analysis of the Urine. By John Marshall, m.d., Chemical Laboratory, Univ. of Penna; and Prof. E. F. Smith, ph.d. Col. Plates. Cloth, 1.00 Memminger. Diagnosis by the Urine. Illustrated. Cloth, 1. 00 Tyson. On the Urine. A Practical Guide to the Examination of Urine. With Colored Plates and Wood Engravings. 7th Ed. Enlarged. i2mo. Cloth, 1.50 Van Niiys, Urine Analysis. Illus. Cloth, 2.00 VENEREAL DISEASES. Hill and Cooper. Student's Manual of Venereal Diseases, with Formula. Fourth Edition. i2mo. Cloth, 1.00 4^* See pages 14 and 15 for list of ? Quiz-Compends t ?QUIZ-COMPENDS? The Best Compends for Students' Use in the Quiz Class, and when Pre- paring for Examinations. Compiled in accordance with the latest teachings of promi- nent Lecturers and the most popular Text-books. They form a most complete, practical, and exhaustive set of manuals, containing information nowhere else col- lected in such a condensed, practical shape. Thoroughly up to the times in every respect, containing many new prescriptions and formulae, and over two hundred and fifty illustrations, many of which have been drawn and engraved specially for this series. The authors have had large experience as quiz-masters and attaches of colleges, with exceptional opportunities for noting the most recent advances and methods. Cloth, each $1.00. Interleaved for Notes, $1.25. No. 1. HUMAN ANATOMY, " Based upon Gray." Fifth Enlarged Edition, including Visceral Anatomy, formerly published separately. 16 Lithograph Plates, New Tables, and 117 other Illustrations. By Samuel O. L. Potter, m.a., m.d., m.r.c.p. (Lond.), late A. A. Surgeon U. S. Army, Professor of Practice, Cooper Medical College, San Fran- cisco. Nos. 2 and 3. PRACTICE OF MEDICINE. Fourth Edi- tion. By Daniel E. Hughes, m.d., Demonstrator of Clinical Medicine in Jefferson Medical College, Philadelphia. In two parts. Part I. — Continued, Eruptive, and Periodical Fevers, Diseases of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, Kidneys, etc. (including Tests for Urine), General Diseases, etc. Part II. — Diseases of the Respiratory System (including Phy- sical Diagnosis), Circulatory System, and Nervous System; Dis- eases of the Blood, etc. *#* These little books can be regarded as a full set of notes upon the Practice of Medicine, containing the Synonyms, Definitions, Causes, Symptoms, Prognosis, Diagnosis, Treatment, etc., of each disease, and including a number of prescriptions hitherto unpub- lished. No. 4. PHYSIOLOGY, including Embryology. Sixth Edition. By Albert P. Brubaker, m.d., Prof, of Physiology, Penn'a College of Dental Surgery; Demonstrator of Physiology in Jefferson Medical College, Philadelphia. Revised, Enlarged, with new Illustrations. No. 5. OBSTETRICS. Illustrated. Fourth Edition. By Henry G. Landis, m.d.. Prof, of Obstetrics and Diseases of Women in Starling Medical College, Columbus, O. Revised Edition. New Illustrations. BLAKISTON'S ? QUIZ-COMPENDS ?. No. 6. MATERIA MEDICA, THERAPEUTICS, AND PRESCRIPTION WRITING. Fifth Revised Edition. With especial Reference to the Physiological Action of Drugs, and a complete article on Prescription Writing. Based on the Last Revision of the U. S. Pharmacopoeia, and including many unofficinal remedies. By Samuel O. L. Potter, m.a., m.d., m.r.c.p. (Lond.), late A. A. Surg. U. S. Army ; Prof, of Practice, Cooper Medical College, San Francisco. Improved and Enlarged, with Index. No. 7. GYNECOLOGY. A Compend of Diseases of Women. By Henry Morris, m.d., Demonstrator of Obstetrics, Jefferson Medical College, Philadelphia. 45 Illustrations. No. 8. DISEASES OF THE EYE AND REFRACTION, including Treatment and Surgery. By L. Webster Fox, m.d., Chief Clinical Assistant Ophthalmological Dept., Jefferson Med- ical College, etc., and Geo. M. Gould, m.d. 71 Illustrations, 39 Formulae. Second Enlarged and improved Edition. Index. No. 9. SURGERY, Minor Surgery and Bandaging. Illus- trated. Fourth Edition. Including Fractures, Wounds, Dislocations, Sprains, Amputations, and other operations; Inflam- mation, Suppuration, Ulcers, Syphilis, Tumors, Shock, etc. Diseases of the Spine, Ear, Bladder, Testicles, Anus, and other Surgical Diseases. By Orville Horwitz, a.m., m.d., Demonstrator of Surgery, Jefferson Medical College. Revised and Enlarged. 84 Formulae and 136 Illustrations. No. 10. CHEMISTRY. Inorganic and Organic. For Medical and Dental Students. Including Urinary Analysis and Medical Chemistry. By Henry Leffmann, m.d., Prof, of Chemistry in Penn'a College of Dental Surgery, Phila. Third Edition, Revised and Rewritten, with Index. No. 11. PHARMACY. Based upon " Remington's Text-book of Pharmacy." By F. E. Stewart, m.d., ph.g., Quiz-Master at Philadelphia College of Pharmacy. Third Edition, Revised. No. 12. VETERINARY ANATOMY AND PHYSIOL- OGY. 29 Illustrations. By Wm. R. Ballou, m.d., Prof, of Equine Anatomy at N. Y. College of Veterinary Surgeons. No. 13. DENTAL PATHOLOGY AND DENTAL MEDI- CINE. Containing all the most noteworthy points of interest to the Dental student. By Geo. W. Warren, d.d.s., Clinical Chief, Penn'a College of Dental Surgery, Philadelphia. Illus. No. 14. DISEASES OF CHILDREN. By Dr. Marcus P. Hatfield, Prof, of Diseases of Children, Chicago Medical College. Colored Plate. Bound in Cloth, $1. Interleaved, for the Addition of Notes, $1.25. These books are constantly revised to keep up with the latest teachings and discoveries, so that they contain all the new methods and principles. No series of books are so complete in detail, concise in language, or so well printed and bound. Each one forms a complete set of notes upon the subject under consideration. Illustrated Descriptive Circular Free. JUST PUBLISHED. GOULD'S NEW Medical Dictionary compact. CONCISE. PRACTICAL. AGGURATE. IcOiMPREHENSIVE UP TO DATE. It contains Tables of the Arteries, Bacilli, Gan- glia, Leucomaines, Micrococci, Muscles, Nerves, Plexuses, Ptomaines, etc., etc., that will be found of great use to the student. Small octavo, 520 pages, Half-Dark Leather, . $3.25 With Thumb Index, Half Morocco, marbled edges, 4.25 From J. M. DaCOSTA, M. D., Professor of Practice and Clinical Medicine, Jefferson Medical College, Philadelphia. "I find it an excellent work, doing credit to the learning and discrimination 0/ the author." *** Sample Pages free.