TV V <■ < \ <^ $M ;'«3 ■■ *n . *&] *S*J ' ^ 1' ..: ji ■*i p> Jvl ■ : M p-* S*J N fgf;^. WA B985e 1889 62921260R NLfl D512TAA7 D NATIONAL LIBRARY OF MEDICINE SURGEON GENERAL'S OFFICE LIBRARY Section------------------------ Formll3o no...................... W.D..S.O.O. D. 8. OOVIBNUINT PHINTINO OFFICK: 1018 NLM051298870 Frontispiece. Ur'"'(f EMERGENCY NOTES. WHAT TO DO IN ACCIDENTS AND SUDDEN ILLNESS UNTIL THE DOCTOR COMES. GLENTWORTH R. BUTLER, A.M., M.D. One of the Physicians to St. Mary s, St. John's, and Methodist Episcopal Hospitals, Brooklyn. Medical Director, Red CrossSociety of Brooklyn, Lecturer on Emergencies and Home Nursing at Pratt Institute ; and on Emergencies at the Brooklyn Normal School for Physical Education. a^itj) ISiflfjtten ©uglnal KllustratioiiH y'" ( JUL NEW YORK: FUNK & WAGNALLS, Publishers, 18 & 20 Astor Place. 1889. All Rights Reserved. WA fc>2>85e- i Entered, according to Act of Congress, in the year 1889, by FUNK & WAGNALLS, In the Office of the Librarian of Congress at Washington, D. C. PREFACE. This small volume is the result of some ex- perience in giving courses of lectures to non- medical people. It contains nothing but that which should form a part of the mental equip- ment of every well-educated man and woman. There is nothing original between its covers except the illustrations. The information con- tained therein is the common property of the medical profession. I venture to hope, how- ever, that the selection and arrangement of mat- ter is practical and useful. Anatomy and physi- ology have been introduced only to the extent required for comprehension of a given subject, and immediately preceding that subject. Any further information desired should be sought for in one of the many popular text-books of physi- ology. In treating of these subjects the great difficulty is to know what to omit. The use of a manual like this is twofold : i. As a text-book for societies which make the diffusion of this branch of knowledge their sole aim, or for schools which give it a place in their course of instruction. Subsequently it will con- iv PREFACE. stitute a complete set of notes on such a course of lectures. 2. As a book of reference for household use. It is strongly recommended that, in places where no such society or school exists, a physician be secured to deliver four or five lectures on those points which should be personally learned and practised. A class numbering from three to ten may be formed in any community, and the usefulness of such a course will more than com- pensate for the little trouble involved. It is no small thing to know what to do and how to do it in accidents or sudden illness. A list of the things which should be practically demon- strated will be found immediately preceding the index. The index has been made ample for the pur- pose of reference in emergencies, or at other times. I am indebted to a clever artist of Pratt Insti- tute, and one of her pupils, for putting my ideas for illustrations into shape. Indebtedness should also be expressed, with- out detailed acknowledgment, for ideas and hints derived from the handbooks of Esmarch of Germany, Shepherd of England, Morton of New York, and Fowler of Brooklyn, all admir- able in their way, especially the latter, which is designed for the guidance of the surgeons and members of the National Guard, State of New PREFACE. v York. But there appeared to be a demand for a manual differing in some respects from those mentioned. Hence this attempt to supply it. A word or two in regard to the interest which has been shown in this general subject. Courses of lectures were first given by Esmarch of Kiel, who founded in 1882 the " Samaritan Society." It was quickly followed by the " St. John's Am- bulance Association" in England. In America the first organization of the kind was the " So- ciety for Instruction in First Aid to the In- jured." A branch society was formed in Brooklyn, which has since acquired an inde- pendent footing under the name " Red Cross Society of Brooklyn." The latter has done excellent work during its existence. Three years ago " Emergencies" were made a part of the curriculum at the Brooklyn Normal School for Physical Education. One year ago it was made, in connection with lectures on Home Nursing, a department of Domestic Science at Pratt Institute, Brooklyn. These facts are men- tioned to show that the utility of such a course of training has been recognized. Glentworth R. Butler, M.D., 402 Franklin Avenue, Brooklyn, N. Y. OUTLINE OF CONTENTS. PAGE The circulation of the blood............................ o Bleeding or haemorrhage............................... 17 Means for stopping haemorrhage........................ 20 Wounds........................................ 2- Poisoned wounds............................... ~2 Bleeding from nose, stomach, and lungs................. 34 The bones. Temporary treatment of fractures........... 38 Dislocations and sprains......................... 4g Burns and scalds. Frost-bites......................... 5o Treatment of drowning and suffocation.................. 52 Foreign bodies in throat, nose, and eye.................. 60 Convulsions and croup....................... g2 Unconsciousness and shock............................. 6, Poisoning............................... go Transportation of the sick and injured................. 74 Bandages and bandaging....................... g0 Things to be personally practised and studied ......... 01 LIST OF ILLUSTRATIONS. PAGE Frontispiece. Carrying the injured, two helpers. Figs, i, 2. Diagram illustrating action of biceps muscle n Fig. 3. Diagram of the circulation of the blood....... 13 Fig. 4. Diagram showing arrest of bleeding from a severed artery............................ 19 Fig. 5. Diagram representing healing of wounds....... 26 Fig. 6. The skeleton.............................. 39 Fig. 7. Diagram representing the healing of a fracture. 44 Fig. 8. Improvised splints and dressings for fractures. 47 Fig. 9. Treatment of drowning. Letting water run out of windpipe.............................. 54 Fig. 10. Treatment of drowning. Artificial respiration, first movement........................... 56 Fig. 11. Treatment of drowning. Artificial respiration, second movement........................ 58 Fig. 12. Carrying the injured, one helper............. 75 Fig. 13. Handkerchief ring seat...................... 77 Fig. 14. Carrying the injured, two helpers............ 78 Fig. 15. Diagram of triangular bandage............... 84 Figs. 16, 17. Application of triangular bandage....... 86, 87 EMERGENCY NOTES. THE CIRCULATION OF THE BLOOD. In order to understand the circulation of the blood, it is necessary to know the structure and action of a muscle. Lean meat, as it is found in the butcher-shop, consists almost entirely of muscle. To the unaided eye it is a soft, red mass. Human muscle resembles in its appear- ance the lean part of beef. In the human body there are several hundred separate muscles, varying in shape and size. These soft, red masses possess a peculiar power or property termed contractility. The term means simply that a muscle is able to shorten and thicken. Most muscles are comparatively long and narrow, and their ends are attached to separate bones. It is evident that when the muscle contracts— that is, shortens and thickens, its ends are brought nearer together, and with these ends move the bones or other structures to which they are attached. Take the large muscle on the front of the upper arm, which stands out so prominently when the hand is brought to the 10 EMERGENCY NOTES. shoulder—the biceps muscle. Like almost all other muscles it is attached, not directly to the bones, but by means of a tendon. A tendon in its typical form is a round, white, glistening cord, very strong, but not elastic—that is, it does not grow longer when pulled upon. Sup- pose it is desired to bend the arm : the muscle contracts—that is, shortens and thickens, in obedience to the will. As it contracts it pulls upon both tendons. One tendon is attached, in the present case, to an immovable bone—the shoulder-blade ; the other to movable bones— those of the forearm. Consequently the latter yield, and the forearm is brought up toward the shoulder. All the movements and activities of the body are carried on by similar mechanisms, the muscles varying in shape, size, and points of attachment, according to the work required of them. (See Figs, i, 2.) It is evident from these considerations that very many of the muscles which form the mass of the body and limbs are under the control of the will. They form a class called voluntary muscles. There are, however, many small muscles which are not controlled by the will— that is, involuntary muscles. They are found forming one layer of the wall of the stomach and intestines, and smaller blood-vessels. The act of breathing is to a large extent involuntary, for if it depended upon the will, one would oc- ACTION OF MUSCLES. II Fig. i. Fig. 2. Diagram illustrating action of biceps muscle. In both figures A represents the point of the shoulder-blade, B the bone of the upper arm, C the bones of the forearm, D the elbow-joint, E the biceps muscle, FF the tendons connecting the muscle at each end to the bones. Fig. 1 represents the muscle at rest. Note shape of muscle E, and position of forearm. Fig. 2 represents the muscle in action. Note altered shape of muscle E (shorter and thicker), and change of position in forearm. 12 EMERGENCY NOTES. casionally forget to breathe. But what have these facts to do with the circulation of the blood ? Simply this, that the heart is an invol- untary, hollow muscle, peculiarly shaped, and arranged to act as a force-pump. It is shaped like a pear, and is somewhat larger than a man's fist. It lies in the chest behind the breast- bone, point downward, and to the left. It is divided, first, into two main cavities, a right and a left. Each main cavity is again divided into two, an auricle and a ventricle. See Fie. 3, which shows in the simplest form the heart, blood-vessels, and circulation, without reference to special blood-vessels. Off from the left ven- tricle leads a great vessel which sends first two large branches to the head, then one to each arm, and passing down the body, finally divides into two, one for each lower limb. As these branches are followed, they are found dividing and subdividing still further, until they form an interlacing network of the finest and most deli- cate tubes, much too small to be seen by the unaided eye. Still tracing these fine tubes, they are found joining and running together to form larger ones. These, in turn, unite, until finally two large vessels are formed which enter the right auricle. From the right ventricle in its turn a great vessel passes to the lungs, divides, sub- divides, unites, and finally forms three or four large vessels, which enter the left auricle. CIRCULATION OF BLOOD. 13 Qa.l>'\Ue.r\tt of /u»)g5 Pulmonary Circulation S^sttinie Circulafion. Fig. 3. Diagram of the circulation of the blood. 14 EMERGENCY NOTES. A few words now about the blood-vessels. There are three kinds : i. Arteries. These are the vessels which carry blood away from the heart. They are thick and elastic tubes, and have no valves. 2. Capillaries. These are the minute vessels which form the connecting network between arteries and veins. 3. Veins. These are the vessels which carry blood to the heart. They are thin-walled, col- lapsible, and provided with valves which allow the blood to pass in only one direction. It will be easy now to trace the circulation of the blood, starting with the left ventricle. It is filled with bright red blood which has just come from the lungs. Recall the fact that the heart is a living force-pump, which contracts seventy to seventy-five times a minute. Contracting, it sends the blood out through the great artery (aorta) and its branches, first to the head and brain, then to the arms, afterward to the body and lower limbs. The blood now passes into the capillaries, and here it shows a striking change of color. Bright red before, it enters from the capillaries into the veins dark blue in color. The red tint was due to the presence of oxygen, and the absence of impurities. While passing through the capillaries the tissues of the body robbed it of its oxygen and added an im- purity—carbonic acid gas. Hence its change of CIRCULATION OF BLOOD. 15 color. Through the veins back to the heart it flows, entering the right auricle, from this to the right ventricle, and then through a great artery to the lungs. In the capillaries of the lungs it casts off the impure carbonic acid gas, absorbs oxygen, becomes again bright red and pure, and returns to the left auricle, and ventricle, to take a new start. So well does the heart perform its task, that all the blood in the body makes its round at least once every minute. Why does the heart invariably pump the blood in the same direction ? Because in the heart, between auricles and ventricles, and at the openings where the great arteries begin, are valves or trap-doors, so arranged that the cur- rent must always flow in the same course. Studying carefully the diagram in Fig. 3, the course of the blood may be summed up as fol- lows : From the left ventricle through a great artery (aorta) to the capillary system of the body ; from these capillaries to the right auricle ; right au- ricle to right ventricle ; right ventricle to lungs and their capillary system ; lungs to left auricle ; left auricle to left ventricle, the place of begin- ning. The circulation from heart to lungs, and lungs to heart, is sometimes called the lesser, or pul- monary circulation. The circulation from heart to body, and body l6 EMERGENCY NOTES. to heart, is sometimes called the greater, or sys- temic circulation. It is at times very necessary, in cases of severe bleeding, to know the exact location of the larger arteries ; for an artery is an elastic tube, and if it is pressed upon at the right place, and with the proper amount of force, it is evi- dent that the flow of blood through it may be stopped, just as one might pinch a rubber tube through which water was running. The follow- ing list shows the arteries which should be studied. It is impossible to learn these facts without the personal aid of a physician, or other person familiar with anatomy, who can show you the exact place where the vessel may be compressed : Arteries. Of neck. (Carotid?) . . Collar-bone artery. (Sub- clavian.) Artery of upper arm. (Brachial.) Arteries of forearm. (Radial, toward thumb ; Ulnar, toward little finger.) Of thigh. (Femoral.) I Landmarks. Large muscle of neck. Middle of collar-bone. (Clavicle.) Biceps muscle.......... Each side front of wrist. Between middle line of body in front, and pro- jecting point of hip- bone. (Symphysis, and A nterior Superior Spinous Process.) I Point of Compression. | Against spine. Against first rib. Against upper arm-bone. (Humerus.) Against bones of forearm at wrist. (Radius, Ulna.) Against front of hip- bone. HEMORRHAGE. 17 BLEEDING OR HEMORRHAGE. The word haemorrhage is a technical term, and means simply, bleeding in general, from any source or cause. It is evident that bleeding ' may occur from three sources, according to the kind of vessel which has been wounded. It is possible also to determine the source of the blood by its color, and the manner in which it flows. Thus there are three varieties of bleed- ing : 1. Arterial. The blood from a wounded artery is bright red. It flows in jets, each jet or spurt corresponding to a contraction of the force- pump propelling it, which is the heart. 2. Capillary. The blood from wounded cap- illaries is also bright red, but oozes out grad- ually, very much as perspiration appears on the face or hands on a hot day. 3. Venous. The blood is blue or purple when issuing from a wounded vein, and flows in a steady, uniform stream. In very slight zvounds or injuries the bleeding is almost entirely from the capillaries. These vessels are so numerous and so small that the point of a needle thrust into the skin at any point will wound them, as shown by the escape of a minute drop of blood. In severe wounds the bleeding is of all three kinds, arteries, veins, and capillaries having i8 EMERGENCY NOTES. been severed. As a rule, in these severe wounds, it is the arterial bleeding which re- quires attention, and hence the importance of being able to recognize it. Almost the only example of purely venous bleeding is caused by the rupture or bursting of enlarged (varicose) veins in the leg. As a matter of fact many cases of bleeding stop spontaneously without treatment. Nat- urally one should know how nature accomplishes. this result, even when the haemorrhage is from an artery. i. Take the case of an artery which has been cut across. Study further the structure of an artery. Its wall is composed of three layers or coats—an outer, a middle, and an inner. It is, as a whole, an elastic, rubber-like tube, kept in a state of fulness or distension by a fluid—the blood—which is constantlv being pumped into it by the heart. It is on the stretch sidevvise and lengthwise. When it is cut it suddenly con- tracts—that is, grows smaller. It also retracts —that is, grows shorter and draws back. At the same time the inner coat, which is the thin- nest, curls up inside the vessel. The combined result of these changes is to make the opening at the cut end much smaller, and by so much hinder the escape of blood. At this point an important property of the blood comes into play. Inside the vessels under usual circum- HEMORRHAGE FROM AN ARTERY. *9 stances it is a fluid. If it gets out, or if the walls of the vessels are injured, it clots or coagulates —that is, becomes semi-solid, like a firm jelly. In this instance it clots firmly in the artery, and in the wound itself, plugging the open end of the vessel, and the bleeding is stopped. (See Fig. 4.) There is still another agency which Fig. 4. Diagram showing the arrest of bleeding from a severed artery. The dotted lines show the original shape and size of the vessel. The solid lines show the contraction (growing smaller), re- traction (growing shorter), and curling in of the inner coat. The shading shows the clot (plug) formed in the end of the vessel, and clot in the wound pressing. may have the desired effect. . If much blood is lost fainting is caused. This means that the action of the heart is weakened. If the action of the heart is weakened the blood is pumped through the vessels with lessened force, and time is afforded for the formation of a clot. It is in this way that men left on a battle-field have recovered from wounds of large arteries. 20 EMERGENCY NOTES. But this fortunate termination is the exception. The facts are, that only in the smallest arteries are the natural processes often sufficient. In medium-sized arteries haemorrhage is some- times stopped by nature, but almost invariably requires aid, the force and size of the stream being such that a clot has no chance to form. In the largest arteries the force and size of the stream is yet greater. The loss of blood is sud- den and large, causing death almost immediately. 2. In the capillaries the vessels are small and the force of the stream slight, so that clotting promptly occurs. The one exception to this statement is found in certain families—fortu- nately few in number—called "bleeders." In these people the blood does not clot, and they have been known to die of long-continued haem- orrhage from a slight cut, or the extraction of a tooth. 3. In veins. These vessels collapse easily as a rule, and the force of the current is not great. Both of these conditions allow quick and easy clotting of the blood. MEANS FOR STOPPING HEMORRHAGE. 1. Elevation. If, for instance, the hand has been cut, it should be raised high above the head. In this position the blood has to travel an uphill road, and it reaches the hand with less force than if the hand were hanging at the MEANS FOR STOPPING HEMORRHAGE. 2 1 side. Lessened force means a slower escape of blood, and a quicker clotting in the wounded vessels. This instance will explain the utility of raising the bleeding part, whenever possible, above the level of the heart. 2. Cold and heat. Cold of a certain degree and heat of a certain intensity have a similar effect upon the blood-vessels, especially small arteries, in causing them to contract. Cold water, ice, or ice-bags applied to a wound tend to stop bleeding. Hot water at a temperature of 115° to 1250, which is as hot as can be com- fortably borne by the hand, has a similar action, and does not depress the patient. Lukewarm water increases bleeding. 3. Styptics. Styptics are substances such as iron, alum, and tannin, which pucker up the bleeding surfaces, just as they pucker the tongue when held in the mouth. Cobwebs packed into the wound is a popular method of treatment, which may be classed under this head. These means are mentioned but to be condemned. They are useful only in capillary bleeding, which can be easily checked by pressure, and all of these means, especially the use of cobwebs, soil the wound and greatly hinder its healing. The only thing which should ever be used as a styp- tic on a wound is a mixture of one part of vine- gar to four parts of water. 4. Pressure directly on wound by, 22 EMERGENCY NOTES. a. The fingers. This is the simplest and most natural method of stopping bleeding from all wounds in which the bleeding is severe. It will, with very rare exceptions, check haem- orrhage temporarily until other more permanent means can be used. Many lives have been lost from ignorance of this simple expedient. Lay one finger above and one below the wound close to its edges, crowd the edges together, and make pressure, b. By compress and bandage. A compress consists of soft material (see section on bandages and dressings), clean linen, muslin, or cheese cloth, folded into suitable shape and size, laid upon the wound, and bound firmly on by a bandage. 5. Pressure on artery above wound, a. By the fingers. Knowing the course and location of the artery, and the exact point at which pressure should be made, it will be an easy matter to stop the flow of blood through the vessel. The amount of pressure required will be very slight, if properly applied, as a per- sonal experiment will prove. b. By an improvised tourniquet. This may consist of an elastic cord or band, like a rubber tube or a suspender, wound tightly round and round a limb above the point of injury, until the vessels are compressed sufficiently to stop the flow of blood. More commonly a handker- WOUNDS. 23 chief is employed. Tie this around the upper arm, for instance, loose as regards the arm, tight as regards the knot. Pass through the handkerchief a stick, pencil, or penknife, and twist in such a manner as to tighten the loop of the handkerchief around the arm, continuing to tighten until the bleeding ceases. (See Fig. 16, left arm.) This pressure may be continued for at least an hour without injury, longer if necessary in an emergency. This and the pre- vious expedient can only be employed in wounds of the limbs. Bleeding from wounds of the body must be treated by pressure on the wounded point. 6. For the permanent stoppage of bleeding from wounded arteries and veins, the surgeon employs ligatures—silk or catgut threads tied around the cut end of the vessel, just as one would tie up the end of a rubber tube. 7. To stop haemorrhage from a ruptured vari- cose vein which usually occurs in the leg. Place the patient on his back, raise the limb and rest it on pillows. Remove garters, if above point of rupture. This should be done, because the flow in the veins is upward toward the heart, and it should not be hindered. If so, the veins below become full of blood. Then bind a compress directly on the bleeding point and the haemorrhage will be promptly and easily stopped. 24 EMERGENCY NOTES. Do not give stimulants in any case of haem- orrhage until the bleeding has been perma- nently stopped. Stimulants increase the force of the heart's action and thereby tend to delay clotting. (Pressure on wound, application of compresses, pressure on arteries, and improvised tourniquet, should be personally practised under the direction of a physician, or other competent person.) This consideration of haemorrhage naturally leads to a similar study of the most common cause of bleeding-namely, WOUNDS. Wounds are divided into three kinds, with reference to their cause : Incised, Lacerated and Contused, Contusions. Incised wounds.—An incised wound is one made by a sharp-cutting instrument, as, for in- stance, a finger cut with a keen penknife. Its edges are clean-cut, its surface smooth. Of all wounds the incised wounds are apt to bleed most freely, because the vessels are cleanly cut and do not favor the clotting of the blood. Lacerated and contused wounds. —These wounds are made by a tearing or bruising instrument, for example, catching the hand on a nail, or breaking through the skin with a blow from a hammer. The edges and surfaces of these WOUNDS—MODE OF HEALING. 25 wounds are rough and ragged. As a rule, they bleed but little. Contusions. — A contusion is simply a bruise caused by a blow from some blunt instrument. The skin is not torn through. It is really a wound under the skin (subcutaneous). Num- berless capillaries are ruptured, and the blood escapes from them into the surrounding tissues, thus causing the familiar black and blue appear- ance of a bruise. The mode of healing of wounds.—Wounds heal in two ways : Primary union, or first intention.—This is by far the most desirable manner of healing, and occurs mainly in incised wounds. If the edges of a wound are clean-cut, brought closely in con- tact and kept there, the wound will heal quite firmly in three or four days. No better illustra- tion can be used than to say that it heals as if the edges and surfaces had been glued together immediately after the injury. (See Fig. 5, A.) Secondary union, or seco?id intention (by granu- lation).—This mode of healing occurs mainly in lacerated and contused wounds. In these wounds there is either actual loss of tissue, or the tissues are so ragged and bruised that it is equivalent to such loss. The destroyed tis- sue or flesh has to be replaced. If you examine a wound of this kind three or four days after it occurred, you will see the bottom of the wound 26 EMERGENCY notes. A Fig. 5. Diagram representing healing of wounds. A. Primary union, or first intention. Dotted line represents wound gaping open. Solid line represents same wound as healed. The vertical line representing the line of union. B. Secondary union, second intention, or by granulation. Dotted line represents extent of original wound. Absolute loss of tissue. Solid line represents same wound filled with granulations, and covered with new skin. WOUNDS—MODE OF HEALING. 2J covered with small red elevations, coated per- haps with a layer of creamy matter. Day by day as you watch it you see these red elevations, termed granulations, increasing in number and gradually filling up the wound. As soon as they reach the level of the skin, and not till then, the skin begins to grow from the edges to the centre, until finally the newly-formed tissue is covered by newly-formed, thin, and whitish skin. The whole of the new tissue forms the scar with which every one is familiar. (See Fig. 5, B.) The scar from a wound healing by first intention is narrow and line-like, that from heal- ing by second intention varies in shape and size, according to the shape and size of the original wound. In primary union the time of healing is short—three or four days. In secondary union the time required varies from a week or ten days to many weeks, according to circumstances. There are certain things necessary to healing by first intention. They are also necessary to safe, although slower, healing by second inten- tion. Hemorrhage must be stopped. The edges of the wound must be brought together and kept there.— The necessity for so doing, if you wish to obtain union by first intention, is evident. Unless the edges of the wound are in contact the so-called gluing process cannot occur. Even in wounds which cannot heal by first intention, it is an ad- 28 EMERGENCY NOTES. vantage to have the size of the wound reduced by bringing the edges of the wound together as closely as possible. The injured part should be put and kept at rest. —Movement and disturbance of the parts hin- ders the healing process. A cut on the finger, unless protected, will heal slowly, because it is constantly being torn open and irritated. Drainage.—This means that if there is to be any discharge from a wound, some method must be used to let it escape as fast as formed. This can only be done by the surgeon. He will use commonly, rubber tubes of various sizes, which are inserted into all wounds of any size, to carry off fluids which ought not to remain. If they do remain, they separate the surfaces of the wound, and cause painful delay in healing. Antisepsis.—This is the most important of all requirements for the proper and safe healing of wounds. The word antisepsis means " anti- poisoning." As used here, the term signifies absolute cleanliness and purity of a wound. There are two kinds of dirt with which the sur- geon must contend. One kind is the dirt which is visible to the unaided eye, for example, dust, pieces of clothing, soil, grime, bits of glass, etc. The other and the more dangerous kind of dirt consists of microscopic living particles, called germs, or bacteria. They float to a cer- tain extent in the air, but cling mainly to ob- WOUNDS—THINGS NECESSARY FOR HEALING. 29 jects of all kinds—hands, clothing, furniture, etc. If they get into wounds and find a suitable soil or resting-place, they begin to multiply and increase greatly in number. Their mere pres- ence is irritating to the tissues of the body, but in addition, while multiplying, they form poi- sonous substances which have a very unpleasant effect both upon the wound and the whole body. By their presence and products they may and do cause inflammation, formation of matter (sup- puration), erysipelas, and certain forms of blood-poisoning. How, then, can we prevent mischief from such a cause ? Simply by remem- bering that they are living particles. By years of delicate and careful experimenting, certain substances have been found which will either kill or benumb these germs, stop their growth and render them harmless. The substances which kill germs are called germicides, those which benumb them and hinder their growth are called antiseptics. The best example of a germicide is a solution of corrosive sublimate, one part to two thou- sand parts of water. As this is very poison- ous, if taken internally, and is not likely to be at hand in an emergency, we must depend upon the antiseptics which can be procured more or less easily. These are, carbolic acid, salt, and vinegar, which may be used in solutions of the following strengths : 3o EMERGENCY NOTES. a. Carbolic acid. Three teaspoonfuls to one pint of water. b. Table or kitchen salt. One tablespoonful to one pint of water. c. Vinegar. One tablespoonful to four of water. By washing the wound and wetting the compress to be bound upon it in one of these solutions, you may feel quite sure that you have prevented the troubles which may arise from the presence of germs. For practical purposes the facts hitherto stated in regard to wounds and bleeding should be con- densed and arranged so as to furnish a set of rules applicable to the proper treatment of wounds, and bleeding therefrom, as they might be met with in actual cases. Hence the follow- ing DIRECTIONS FOR THE TREATMENT OF WOUNDS AND BLEEDING FROM THEM. A. In trivial wounds, or large wounds with slight hemorrhage, or where hcemorrhage has stopped be- fore seeing the case. i. Wash with antiseptic solution. Do not dis- turb clot if previous haemorrhage has been large. 2. Make a compress, wet it in an antiseptic solution, and apply with bandage. If bleeding is severe at the time of seeing the TREATMENT OF WOUNDS. 31 case, the rules given above must be modified and added to. Therefore, in B. Large or small wounds with much Jicemor- rhage, 1. Cut away clothing so as to expose the part. 2. Make pressure with the fingers on both sides of the wound, above and below, elevating the part at the same time, if a limb. In the mean time, still continuing the pressure, 3. Secure, if possible, clean material for com- press and bandage, and also one of the antisep- tic solutions to wet them with. If the case is urgent, obtain any kind of material, dispense with^the antiseptic, and, 4. Prepare a large compress and bind it in and on the wound firmly with a bandage. 5. If bleeding still continues, make finger- pressure on the artery above the wound. 6. If this, again, is not effectual, use the im- provised tourniquet. (See Fig. 16, left arm.) The last two methods are not available in wounds of the body or trunk. One must trust to pressure with fingers or compress. Contusions or bruises, which, you will remem- ber, are wounds under the skin, require very simple treatment. The blood which escaped from the capillaries is slowly absorbed, chang- ing color in the process, from blue-black to green, and fading into a light yellow. A black eye from a blow is a comparatively frequent ex- 32 EMERGENCY NOTES. ample of a contusion. As to treatment : Hot fomentations to the part will hasten the disap- pearance of the color. These should consist preferably of old towels or pieces of old flannel, wrung out of very hot water, and applied to the part for a half hour at a time. During this time they should be frequently re-dipped in the hot water. If cooling applications are preferred on the score of convenience, either of the following may be used by wetting linen or muslin cloths and binding them on the part. They should be kept moist : Alcohol and water, equal parts. Alcohol, vinegar, and water, equal parts. Pond's extract (witch hazel). A teaspoonful of laudanum to a cup of water. POISONED WOUNDS. The term refers to the bites of rabid or ven- omous animals. Included under this head are the wounds inflicted by the bite of a snake, or a mad dog or cat. Stings of insects are small poisoned wounds. Treatment.—This must vary in severity and extent, as follows : a. If the bite is judged to be only slightly poi- sonous, or, if doubtful, i. Provided the wound is on a limb (finger, toe, arm, leg), tie immediately a string, cord, or handkerchief twisted into a cord tightly around the limb just above the wound. This will pre- POISONED WOUNDS. 33 vent the entrance of the poison into the circu- lation, as it cannot pass above the ligature. 2. Draw the poison from the wound by means of suction with the mouth. Even the venom of snakes is harmless when taken in the mouth, unless there is a scratch or wound of the lips or mouth. 3. Bathe the part freely in warm water, or, better still, an antiseptic solution, preferably carbolic acid. b. If the bite is known positively to be danger- ous or fatal, use the ligature and suction as be- fore. In addition, 1. Make a cross-cut through the centre of the bite with a penknife. This will encour- age bleeding, which tends to wash the poison away. It also exposes the wound more thor- oughly for the next step in treatment, which is 2. Cauterization. This measure is, of course, painful and apparently brutal, ft should be re- membered, however, that the bite is almost in- variably fatal and a human life is at stake. You have a choice of means. The best is the use of pure nitric acid. Dip the end of a match, or splinter of wood into the acid and thrust it re- peatedly into the depth of the wound, so as to bring the acid in contact with every part of its surface. Pure carbolic acid may be used in the same way. If these are not at hand, a knitting- 34 EMERGENCY NOTES. needle, piece of wire, or knife-blade may be heated, and the wound thoroughly seared. 3. Give stimulants—brandy, whiskey, or wine —in large doses, not enough, however, to pro- duce intoxication. Aromatic spirits of am- monia, a teaspoonful in a wineglass of water, may be given every fifteen minutes. If bitten by a dog do not allow the animal to be killed. By waiting it will be ascertained if the dog is really mad, and many days of anxiety and worry will be spared. For the stings of insects, bind on a compress wetted with carbolic solution, or, better, house- hold ammonia. We have spoken of wounds and of bleeding from obvious injury. Other kinds of haemor- rhage occur not due to obvious injury or vio- lence. The difference is more apparent than real, as in all cases bleeding depends upon the fact that the vessels are in such a condition that the blood can escape from them, and it matters not in reality whether the injury is produced slowly by disease, or quickly by sudden vio- lence. For convenience in treatment, however, we speak of these haemorrhages under separate heads. BLEEDING FROM THE NOSE. This is the most frequent and the least danger- ous of these haemorrhages. It is usually due to BLEEDING FROM NOSE. 35 rupture of some capillaries in the membrane lining the nose, more rarely to ulceration of a small artery. Capillary rupture may be caused by violent exercise. It may occur in heart disease and congestion of the brain. It is sometimes caused by disordered condi- tions of the blood, and is especially frequent in typhoid fever. The blood generally comes from one nostril, and from a point on the partition between the two nostrils, on a level with the lower edge of the nose bone, so that the tip of the finger can reach it. Treatment.—Let the patient sit upright. Leaning forward with the head low increases the bleeding. Raise the arm on the bleeding side. Take two towels and wring them out of cold, preferably ice-water. Wrap one around the neck. Lay the other properly folded over the forehead and upper part of nose. A greater degree of cold may be obtained by wrapping finely cracked ice in the folds of the towels. As stated before, cold causes the vessels to con- tract. If bleeding still continues, snuff up from the hand, or inject with a small syringe, either ice water, or ice-water and alum, a teaspoonful of alum to a cup of water. If these means fail, take a piece of cotton wool as large as the first joint of the thumb, tie a thread around its mid- dle, soak it in the alum-water, or, if that is not at hand, oil it with sweet oil or vaseline, and $6 EMERGENCY NOTES. plug the nostril. This is best done by pushing in the cotton with a screwing or twisting mo- tion, until firmly lodged. The thread serves to draw it out when required. BLEEDING FROM GUMS. This can be stopped by rinsing the mouth freely with alum and ice-water. BLEEDING FROM THE STOMACH. This is caused by ulcer, cancer, inflammation, or corrosive poisons. Sometimes it occurs with- out apparent cause. The symptoms are these. First, a feeling of fulness at the pit of the stom- ach. Then follows pallor of the face, disturb- ance or dimness of sight, finally nausea and vomiting of fluid blood. If the blood has escaped from the vessels into the stomach very suddenly, it appears bright red. If it has escaped slowly and remained in the stomach for some time, it looks like coffee grounds. Blood is an animal substance. If it stays in the stom- ach for a sufficient length of time it is partially digested, and in this condition has the appear- ance of coffee grounds. In a case of this kind remember that there may have been nose-bleed, or bleeding from the gums. This blood, espe- cially during sleep, may have been swallowed, and afterward rejected by the stomach. It is necessarv also to decide whether the blood BLEEDING FROM STOMACH. 37 comes from the stomach or from the lungs. Remember, then, that In bleeding from the stomach, the blood is vomited, and is either bright red, or coffee-ground, not frothy. In bleeding from the lungs, the blood is coughed up, is bright red and frothy. Treatment.—Calm the patient, if possible, for excitement causes increased heart action and a greater amount of bleeding. Let cool air into the room. > Give the patient small bits of ice to swallow. Take a teaspoonful of vinegar and add to it four teaspoonfuls of ice-water. Give the patient a teaspoonful of this mixture every ten or fifteen minutes. Nothing else should be swallowed, and no stimulants should be given. BLEEDING FROM THE LUNGS. This is caused sometimes by disease of the heart, but most commonly by diseases of the lungs, especially consumption. It is very rare- ly, if ever immediately fatal, excepting, possibly, in the last stages of consumption. It is not, therefore, an event which should cause fear of immediate death. It is important mainly as a symptom of disease. The way of distinguishing between bleeding from lungs, and from stomach, has been given in the preceding section. Treatment.—Reassure the patient, which you may conscientiously do. Admit cool air. Let 33 EMERGENCY NOTES. the patient sit or recline. He should not lie flat. Apply cloths wrung out of cold water to the chest and neck. Bits of ice should be swal- lowed. Let him eat a teaspoonful of salt, or wash it down with water. If a physician cannot be procured, you may give a teaspoonful of spirits of turpentine in a tumbler of milk. Do not give stimulants. THE EONES. In order to gain an intelligent idea of the temporary treatment of fractures, one should have, at least, an outline knowledge of the skele- ton and the bones composing it. The skeleton consists of all the bones of the body taken as a whole. The bones give firmness and rigidity to the body. They form the frame-work upon which the soft parts are moulded. Indirectly they constitute the means by which we are able to perform various movements of the body and limbs, for it is the bones to which the muscles are attached. The bones, therefore, form le- vers by which movement is effected. Moreover, they form cavities or enclosed spaces, which contain and protect the more delicate and im- portant organs, such as the brain, the eyes, or the heart. The skeleton, for purposes of study, is divid- ed into the head, the trunk, and the extremities or limbs. THE SKELETON'. 39 m , PONt ss Fig. 6. The Skeleton. 40 EMERGENCY NOTES. (// is impossible to gain a correct idea of the shape, size, and relations of the bones and joints without seeing and examining the actual skeleton. Illustrations and drawings, while by no means use- less, are of little service compared to personal ob- servation and practice. These remarks apply also to the use of splints and dressings. The remainder of this and the two folloiving sections constitute lit- tle more than an attempt to suggest the leading points, which should be the subject of practical study under the guidance of a physician, or other competent per- son.) The Head.—The head is further divided into skull and face. The bones forming the upper part of the skull are flattened and immovably joined by their edges, constituting the roof of a cavity. The bones of the lower part of the skull and of the face are irregular in shape and also firmly knit, with one exception—viz., the lower jaw, which is movable. They form the floor of the cavity, and this cavity contains and protects the brain and organs of special sense. The Trunk. — The trunk is formed by the spine, ribs, breast-bone, and pelvic bones. The spine is composed of a number of separate bones piled one on top of the other, so that they form a col- umn. Each bone is called a vertebra (plural, vertebra). Between each and its neighbor is in- terposed a layer of rubber-like substance called cartilage. The spine is not straight, but has THE BONES. 41 several curves. Being composed of alternate blocks of hard bone and layers of rubber-like cartilage, it has the important property of flexi- bility—that is, the power of bending. This ar- rangement also prevents jarring of the brain in walking and jumping. At the same time it is sufficiently rigid to sustain the weight of the trunk and head. Through the centre of the spinal column runs a canal, in which lies the spinal cord, composed of nerves on their way to different parts of the body. The Ribs and Breast-bone.—The ribs are long, narrow, curved bones, running from the spine behind to the breast-bone (sternum) in front. With the latter they form a cavity, the chest, which contains the heart, lungs, and great blood- vessels. At the back the ribs are jointed di- rectly to the spine, and have but little range of movement. In front they are connected to the breast-bone by strips of cartilage. It is by means of these cartilaginous junctions that the ribs have the power of movement during the act of breathing. Otherwise, the chest would be a box, with rigid, immovable walls. At the base of the chest is attached a muscular mem- brane {diaphragm), which forms a partition be- tween the chest and the abdomen. The abdo- men contains the stomach, intestines, liver, spleen, etc. The Pelvic or Haunch-bones.—These are strong, 42 EMERGENCY NOTES. thick bones, enclosing a cavity called the pelvis. The Extremities or Limbs.—The arm and shoul- der, or upper extremity, consists of the collar- bone (clavicle), the shoulder-blade (scapula), the upper arm bone (humerus), the forearm-bones, two in number (radius and ulna), small bones of wrist and hand. The lower extremity or leg comprises the thigh-bone (femur), the knee-cap (patella), two leg-bones (tibia and fibula), small bones of ankle and foot. Joints are formed by the junction of two or more bones. The surfaces of the bones in con- tact are covered with a thin layer of cartilage. Between the cartilaginous surfaces is placed a thin-walled sac, the inner surface of which se- cretes an oily material, so that the joint-surfaces will move smoothly upon each other. The bones forming the joint are held together by strong but flexible bands called ligaments. There are three kinds of joints. Immovable, as in the skull ; ball and socket, as in the shoulder and hip ; hinge-joints, as in the elbow and knee. FRACTURES. Fracture is the breaking of a bone. As to direction a fracture may be transverse, at right angles to the greatest length of the bone, or oblique, at an acute angle to the greatest length. The character of the fracture may be, THE BONES.—FRACTURES. 43 Simple.—This is a break of a bone without a wound of the skin or flesh. Compound.—In addition to the break there is a wound leading down to the point of fracture. The wound may be caused by the sharp end of a broken bone being thrust through the skin, or by the same force which produced the fracture. Comminuted.—This means that the bone is broken in more than one place. How do fractures heal ? Healing proceeds very slowly for the first four or five days. A jelly-like material forms around the ends, betiveen the ends, and inside the marrow canal of the bone. This gradually hardens, and is finally trans- formed into new bone. This mass of new ma- terial is called callus. (See Fig. 7.) Its size de- pends upon the extent to which the broken ends of the bone remain out of their natural po- sition. In the course of months or }^ears the callus disappears by absorption, leaving the bone about as strong as before. The time required for the healing of a fracture varies from two to six weeks, according to the size of the bone. It is much more rapid in children than in adults. Signs of fracture. 1. Deformity. On comparing a fractured bone with the uninjured one on the opposite side of the body, it is noticed to be out of shape and deformed. The deformity is due to swelling of the soft parts, but mainly to displacement of the 44 EMERGENCY NOTES. ends of the bone. For instance, in a fracture of the upper arm-bone, the broken ends slip past each other, thus causing distortion. Fig. 7. Diagram representing the healing of a fracture. The shaded portion shows the callus. Note that it forms around, between, and inside the narrow canal of the bone. Callus disappears to a great or less extent by absorption. 2. Abnormal mobility. On gently movino- the limb the bone bends unnaturally. In other words, a joint is found where it ought not to be. 3. Crepitus. The same movement of a broken limb which shows abnormal mobility will fre- quently produce a clicking or grating sensation. This sensation is called crepitus, and is caused by the rough surfaces of the broken bone rub- bing against one another. Having decided that a fracture exists by find- ing one or more of these signs, the physician sets (reduces) the broken bone. This means that he puts the ends of the bones into proper posi- tion by manipulation and pulling. He then en- TREATMENT OF FRACTURES. 45 deavors to keep them in proper position, by means of splints, until they knit. Splints usually consist of some rigid or firm material, such as felt, plaster-of-paris, or strips of wood, properly padded, according to the nature and location of the fracture. The broken ends cannot always be kept in proper position, because in some fractures they tend to become displaced by the action of the muscles attached to the bones. This is especially the case in fractures of the upper arm-bone and the thigh-bone. The use- fulness of a limb is sometimes unavoidably di- minished by the presence of a large callus, and its interference with motion by its position and pressure upon the nerves. Compound fractures are especially serious, because there is added to the fracture a wound of a very disagreeable nature. THE TEMPORARY TREATMENT OF FRACTURES. In compound fractures the wound should im- mediately receive proper treatment by applying compress and bandage wet with an antiseptic solution. Afterward treat it as a simple frac- ture. In a simple fracture, 1. There is no great haste necessary, there- fore, if patient does not require to be moved, sim- ply make him as comfortable as possible by propping the injured limb with pillows or cush- ions, and apply cloths wet with cold water. But 46 EMERGENCY NOTES. 2. If patient must be moved, or travel some dis- tance, apply temporary splints or dressings to prevent further injury from movement. In city or country one of the following list of materials may usually be found, and, by the aid of a little ingenuity, utilized for temporary dressings : For Splints.—Cigar-boxes, pasteboard (boxes, book-covers), folded newspapers, shingles, bar- rel-staves, umbrellas, walking-sticks, rulers, paper-cutters, branches, twigs, straw, fence- palings, spoons, tongs. For Padding.—Cotton, flannel, towels, flax, jute, oakum, hay, moss, piece of blanket, coat- sleeves or stockings stuffed with grass, hay, straw, or leaves. For Bandages.—Handkerchiefs, stockings, gar- ters, suspenders, sheets, blankets, and patient's clothing torn into strips. The temporary treatment of the following special fractures should be studied and person- ally practised. Some of these improvised splints and their application are shown in Fig. 8, and in Frontispiece, left leg. See also section on bandaging. Jaw-bone.—Four-tailed bandage. Collar-bone.—Broad bandage around chest and arm of injured side. Broad arm-sling. Upper Arm-bone.—Two splints. Narrow arm- sling. t^ w c4 D h U < to 0 g t/3 w Q Fig. 8. Improvised splints and dressings for fractures of jaw. upper arm, forearm, thigh-bone, and leg. 48 EMERGENCY NOTES. Forearm and Wrist-bones.—One splint reaching to base of fingers. Broad arm-sling. Ribs.—Broad bandage around chest, applied during expiration—i.e., chest emptied of air. Thigh-bone.—Preferably a long, posterior (back) splint, reaching from waist to heel. If this cannot be secured, simply tie limbs to- gether. Leg and Ankle-bones.—Internal (inside) splint, or tie limbs together. DISLOCATIONS. A dislocation is a displacement of the joint ends of one or more bones from their proper position. The ligaments are necessarily torn. Signs of a dislocation.—I. Alteration in shape. Compare with opposite side. 2. Much pain on attempted movement. 3. Abnormal immobility. There is no joint where there should be one. Dislocations should always be treated by a physician, as much damage may be done to blood-vessels and nerves by unskilful handling. They differ from fractures in one respect, that the sooner they are reduced, the better it will be. Hot fomentations should be applied while waiting. SPRAINS. 49 SPRAINS. Ligaments, the bands which hold the joint- bones together, are flexible but not elastic. They will bend easily, but will not lengthen when pulled upon. They may be cut without causing pain or subsequent disturbance ; but if they are overstretched and torn, pain and swelling quickly occur. A sprain is a sudden overstretching and tearing, not only of the lig- aments forming a joint, but also of the tendons and muscles around the joint. In bad cases the bones themselves are bruised. A sprain differs from a fracture or a dislocation by the ab- sence of deformity and other characteristic signs. Treatment.—The joint should be soaked in hot water at once. It should be done properly to be of service. If, for instance, the ankle-joint is sprained, put the foot in a pail of water as warm as can be borne. Every minute or two add hotter water, until the foot will endure no more. Continue this from twenty minutes to half an hour. Remove the foot, rub gently with vaseline or sweet oil, and apply a snugly-fitting flannel roller bandage. If the sprain is of a joint which cannot be treated in this way, apply towels wrung out of hot water and frequently renewed. This will also hasten the disappear- ance of the discoloration usually attending a 50 EMERGENCY NOTES. bruise, which is due to capillary rupture and escape of blood into the tissues. BURNS AND SCALDS. Burns are caused by dry heat. The degree of heat may be very great, as in white-hot iron. Scalds are caused by moist heat, as hot water or steam. Unless superheated under pressure, as in an engine-boiler, the temperature is not above 212° F. Scalds are dangerous according to the extent of surface involved. It is said that if two thirds of the surface of the body is scalded, death inevitably follows. Eschars are burns caused by chemical caustics, such as strong acids or alkalies. The scars resulting from severe burns possess the property of slow contraction to a remark- able degree. If situated over a joint they may cause serious deformity and loss of mobility, requiring an operation for relief. There are three degrees of burns : 1. Painful redness, such as results from a slight scald, sunburn, or the use of a mustard plaster. 2. Formation of blisters in addition to red- ness. First and second degrees involve the skin only. 3. Charring. In this degree the skin is de- stroyed and the underlying tissues as well, to a greater or less depth. TREATMENT OF BURNS AND SCALDS. 51 Treatment. — 1. Cut away the clothing. Do not pull it off. 2. Prick blisters with a large new pin or needle, and gently press out the fluid which they contain, being careful not to tear the raised skin, as it leaves a raw, tender surface. 3. Apply cloths wet with a. solution of bak- ing soda, as much soda as will dissolve in a cup of water. This is especially good for scalds. Apply on muslin or linen either vaseline, cold cream, olive oil, linseed oil, lard, butter, or car- ron oil, which is a mixture of equal parts lime- water and linseed oil. If at hand, the best ap- plication is a solution of carbolic acid, three tea- spoonfuls to one pint of water. Wet cloths with it and lay on burn. It relieves pain by benumb- ing the nerves of the part. If none of these sub- stances are at hand, dust with flour, starch, or toilet powder. In burns from a caustic, if made by an acid, apply the solution of baking soda or lime-water. If from an alkali—for example, lye, apply a so- lution of a teaspoonful of vinegar and two table- spoonfuls of water, or lemon-juice and water, equal parts. Afterward treat it as a simple burn. FROST-BITES. Frost-bites are usually of the ears, nose, hands, or feet. At first the freezing part is blue 52 EMERGENCY NOTES. or purple, and quite painful. After it is thor- oughly frozen it looks waxy white, and no pain is felt. The nerves of the part are frozen, and in this condition lose the power of conveying sensation. Treatment.—Warmth and circulation should be restored gradually. If done suddenly morti- fication (gangrene) is likely to ensue. Put the patient in a cold room. Rub the frozen part vigorously with snow, ice, cloths wet with ice- water, or pour on ice-water. Continue this un- til a burning, tingling pain is felt in the part, when all active treatment should cease. Pain shows that warmth and circulation are begin- ning to return. Cloths wet in cold water should then be bound upon the part. The after effects of a frost-bite are precisely like those of a burn, and require similar treatment. DROWNING. Immersion even for one minute has destroyed life. On the other hand, pearl and sponge div- ers remain under water for two and three min- utes, having acquired such ability by continued practice. There are two kinds of cases met with. In the first as soon as the person falls into the water, a condition which resembles fainting en- sues. The heart beats very feebly. The breath- ing stops, and no water is drawn into the air- DROWNING AND ITS TREATMENT. 53 passages. Restoration to life is more probable than in the second kind, where fainting does not occur, and in an attempt to breathe while im- mersed, water is drawn into the windpipe and lungs. There are certain things which are of great importance to remember if any one is in dan- ger of drowning, always provided that they can retain self-control and presence of mind. The body, as a whole, is lighter than water, and will float if the arms and greater part of the head remain under water. Therefore if any one is in this danger, he should lie flat on the back, keep the arms under water, stretched full length above the head, expire and inspire quickly, hold- ing the air in the lungs after inspiration as long as possible, so as to keep them filled during the greater part of the time. Then wait quietly for assistance. Struggling and throwing the arms out of water will cause the person to sink. RULES FOR THE TREATMENT OF THE APPAR- ENTLY DROWNED. Never stop working until a physician pro- nounces the case hopeless. Remember that the patient is suffering from two things—want of air or oxygen, and loss of heat from the body. Want of oxygen is the pressing need which must be supplied, therefore if the patient is not breathing, artificial respira- Fig. 9. Letting water run out of lungs and windpipe. Note that mouth is lower than base of lungs. Also forehead resting on hand. W w a M a n «i o W 75 TREATMENT OF DROWNING. 55 tion should be commenced and continued, first, last, and all the time. Begin and carry on your work in the following order : i. Cut and tear the clothing from the upper part of the body, to give freedom of movement. 2. Keep in the open air, if the weather per- mits. 3. Turn the body on the face, forehead rest- ing on hand to keep mouth clear of ground. Place a coat or two. made into a roll, under stomach and hips, in order to have a sloping line from base of lungs to mouth. In absence of roll, stand astride of patient, grasp hips and raise high. This will allow water to run out of the windpipe. Assist it by placing a hand on each side of spine at back of chest and pressing forcibly two or three times. (See Fig. 9.) Let this occupy not more than one minute. 4. Turn body on the back. Place roll of clothing under the shoulders. The roll may be dispensed with, if not procurable. 5. Wrap handkerchief around forefinger, pass into the mouth and clear out mucus. Grasp tip of tongue and draw it forward and clown on chin. Have some one hold it there, or, if alone, lay a strip of material on tongue, pass the ends behind the neck and tie. Otherwise the tongue may fall back and close the throat. 6. Then begin artificial respiration (Sylvester's method). Kneel at patient's head. Fig. io. Artificial respiration. First movement—inspiration. Note expansion of chest, and elbows touching the ground. ARTIFICIAL RESPIRATION. 57 First Movement (Inspiration).—Grasp arms at or just below the elbows. Bring the arms up over head and down to the ground, so that the elbows touch the ground. Hold them there for three seconds, or while you count one, two, three, rather slowly. The muscles attached to the upper arm-bone and to the ribs, pull upon the latter so as to expand the chest, and air en- ters the lungs. (See Fig. 10.) Second Movement (Expiration).—From this posi- tion carry arms down so that the elbows rest one upon either side of the front of the chest. Let the weight of your body bear upon the chest and ribs, while you count one, two, three, rather slowly, as if you were endeavoring to squeeze the air out of the lungs, which is, in fact, precisely what you wish to do. (See Fig. 11.) The preceding points are the most important. But the patient is also suffering from loss of heat, therefore, if you have others to aid you, 7. Send for warmed blankets and quilts, bottles or rubber bags filled with hot water ; for bricks, stones, bags of sand or salt, heated in the oven. 8. Send also for brandy, whiskey, wine, or aromatic spirits of ammonia, to be used when patient can swallow. 9. While you are continuing artificial respira- tion, let others remove the remaining wet cloth- ing, apply heat by methods referred to, and rub the limbs vigorously upward. Fig. ii. Artificial respiration. Second movement—expiration. Note pressure upon, and sinking in of chest. DROWNING.—SUFFOCATION FROM GAS. 59 10. From time to time stop artificial respi- ration for a moment, in order to see whether the patient is himself attempting to breathe. Change of color in the face, gasping, or move- ment of the pit of the stomach, are favorable signs. If he begins to breathe do not hinder him by squeezing air out of the lungs when he is making an effort to get it in. Slap the bare chest with a towel wet in cold water, or, better, pour hot and cold water alternately on the chest. Either of these will stimulate the breath- ing, as any one who has gasped under a cold shower-bath will testify. In addition apply smelling salts or ammonia to the nostrils. 11. As soon as the»patient can swallow, give stimulants in hot water and remove him to bed. In all cases of apparent drowning continue your efforts for at least two hours, or until the responsibility is shifted upon a physician. SUFFOCATION FROM GAS. Usually caused by ordinary illuminating gas, but sometimes by the vapor produced by burn- ing charcoal in a closed room. In these cases the patient is suffering not only from want of oxygen, but from poisoning of the blood pro- duced by absorption of gas. The heat of the body is not lost to the same extent as in drown- ing. Treatment.—Give fresh air. Open all doors, 6o EMERGENCY NOTES. and raise or break windows from the outside, if possible. If not, open the door, cover your mouth and nose with a towel wet in water, or water and vinegar. Rush to the nearest win- dow, break a pane, thrust your head out, and take fresh breath. Repeat at the other win- dows. As soon as possible remove the patient to fresh air. I. If the patient is breathing, slap the chest with a cold wet towel, or pour hot and cold water alternately on the bare chest. Let him inhale the fumes of ammonia, or burn feathers under the nose. 2. If the patient is not breathing, perform arti- ficial respiration. • Wrap a hot plate in a towel and lay over heart. As soon as the patient can swallow, give stimu- lants in hot water. FOREIGN BODIES. In Throat.—Choking is usually caused by pieces of food lodging in the throat, or entering the cartilaginous box (larynx) at the upper end of the windpipe (trachea). Death may occur suddenly from the latter cause. i. If a child, invert at once, by seizing the ankles and suspending the child therebv, head downward. While holding him in this position slap the back violently, so as to dislodge the foreign body. FOREIGN BODIES IN THROAT AND EYE. 6l 2. If an adult, slap the back violently. If these means are unsuccessful, then, either in a child or an adult, 3. Seize the nose. Open the mouth and keep it open by thrusting between the teeth the handle of a table-knife, spoon or fork, a pencil, stick, cork, or similar hard substance. Then pass two fingers to the back of the mouth, press the tongue down, and either crook the fingers and try to hook out the foreign body, or grasp it between the fingers and extract it. This proceeding will cause an attempt to vomit which aids in the dislodgment. If these means are ineffectual and the neces- sary assistants are at hand an adult also may be inverted. Place him face downward upon a table, bureau, or desk, slide his head and body over the edge until the trunk and head hang vertically, head downward, letting your assist- ant sit on the legs of the patient to keep the latter from falling off. Then slap the back violently. In a case of this kind it is especially important in sending for a physician, to acquaint him with its nature, as instruments of a special kind are required for its treatment. In Eye. — 1. If the foreign body is corrosive or caustic, as, for example, acids, bits of lime or mortar, the eyes should be freely bathed with a solution suitable for counteracting (neutralizing) its caustic property. 62 EMERGENCY NOTES. For alkalies—lime and mortar—use a mixture consisting of one teaspoonful of vinegar to two tablespoonfuls of water. Lemon-juice in same proportion. For acids, use mixture of baking soda, half a teaspoonful to a cup of water. 2. If the foreign body is not corrosive, as sand, dust, or cinders, do not rub the eyes. Simply close them for some time, and in many cases the free flow of tears will wash out the foreign body. It will most commonly be found on under lid, or inner corner of the eye. If it can be seen by holding the eyelids apart, re- move it by means of a corner of a handkerchief rolled to a point. If there is difficulty in its re- moval always consult a physician or specialist in diseases of the eye. In Nose.—there is no danger except from un- skilful removal. Consult a physician. In Ear.—The same advice, to consult a physi- cian, holds good in this accident, with one ex- ception. If an insect has entered the ear, pour oil or water into the ear-opening, thus drown- ing or floating out the intruder. CONVULSIONS. i. In adults. These are due to various causes, for example, epilepsy or Bright's disease of the kidneys. A true convulsion cannot be stopped after it has once begun. The only thing CONVULSIONS.—CROUP. 6$ that can be done is to prevent the patient from injuring himself. The most usual self-injury is biting the tongue and inside of cheeks. Avoid this by placing between the teeth a cork, or the handle of a knife wrapped in a handkerchief. Use either no restraint, or be very gentle. 2. In children. These are generally due to indigestion, or indigestible food. They occur also at the beginning of, and during the eruptive fevers, for example, scarlet-fever. Treatment.—Put the child in a warm bath as soon as possible. The warmth soothes and quiets the nervous system. If the face is flushed and the head hot apply to the latter cloths wrung out of cold water. If the face is pale do not use cold. The physician should direct any further treatment. CROUP. There are two forms of disease usually called by this name—membranous croup and spas- modic croup. The former is almost invariably diphtheritic in its character, and as it requires a period of time counted by days for its full de- velopment, it does not belong to the catalogue of emergencies. Spasmodic croup comes on suddenly. A child < retires to bed apparently well, or with slight symptoms of a cold. Usually between ten and twelve o'clock at night it wakes suddenly from 64 EMERGENCY NOTES. a sound sleep, with difficult, wheezy breathing, hoarse voice, and loud, ringing, so-called croupy cough. It is very seldom, if ever, fatal. Treatment.—Get some hot water, dip in it a small sponge, or a handkerchief rolled into a ball, squeeze it once and hold it upon the front of the throat just over what is called the " Adam's apple" (larynx), and repeat. Continue this for ten or fifteen minutes, or until the skin is well reddened. In the mean time, if possible, prepare a warm bath and put the child in it. The hot applications and the warm bath relieve congestion and quiet the nervous system, thus relaxing the spasm of the small muscles at the top of the windpipe. The treatment by medi- cation must be directed by the physician, UNCONSCIOUSNESS. Unconsciousness is, technically, the loss of sensation and voluntary motion. It may be due to a variety of different causes, besides those already referred to. It is consequently very difficult at times, even for the physician, to de- termine the exact cause in a given case. To il- lustrate this fact it is sufficient to say that loss of consciousness may be caused by fainting, apo- plexy, intoxication, sunstroke, epilepsy, hys- teria, condition of blood in Bright's disease of the kidneys ; inflammation, injury, compression UNCONSCIOUSNESS.—FAINTING. 65 and concussion of the brain ; fracture of the skull, and narcotic poisons. Treatment.—There are certain general rules of treatment which may be followed in any case, without reference to the cause of the con- dition. 1. Give fresh air. Prevent crowding around the patient. 2. Loosen clothing around neck and chest, so that the breathing may not be hindered. 3. If the face is pale, keep the head low. 4. If the face is flushed, raise the head, and apply cloths or towels wetted with cold water. 5. Do not give stimulants, unless it is un- doubtedly a case of fainting. 6. Obtain all possible information about the case, for it will be of great value to the physi- cian. For example, injury of any kind to head, exposure to heat, or the fact of a convulsion having preceded loss of consciousness. There are some of these cases which it will be of service to describe a little more fully, in re- lation to their symptoms and treatment. Fainting.—If the brain stops acting the person becomes unconscious. To keep the brain in action, it needs a constant supply of blood. If this supply of blood is cut off the person faints —that is, becomes unconscious. The heart is sometimes a very susceptible organ. Any sud- den and strong sensation, mental or physical, 66 EMERGENCY NOTES. painful or the reverse, will at times cause an abrupt weakening of its action. Thus the blood-supply to the brain is stopped for the time, and the person becomes unconscious and sinks in a faint. Treatment.—Lay the patient flat upon the back. The floor will answer admirably. Do not lift him or her to a lounge or bed. As the faint is due to absence of blood from the head, the object of treatment is to get it back to the head. By making the head the lowest point of the body, the force of gravity will give power- ful aid in sending it where it is needed. Do not use a pillow ; it is a hindrance. Keep the head low. At the same tirne loosen the clothing around the neck, sprinkle cold water on the face, and chafe the hands vigorously. Apply ammonia or smelling salts to the nose, and if the faint continues raise the feet higher than the head. A sudden loss of consciousness, which is not soon relieved by these means, and especially if the face is flushed rather than pale, is more than a mere faint. Sunstroke.—A condition produced by expos- ure to heat. The greatest number of cases de- velop on and after the third day of a heated term. There are certain symptoms premonitory of this accident, such as headache, a feeling of weakness, disturbance of the sight, nausea, and, perhaps, vomiting. These symptoms increase in severity until the person becomes uncon- SUNSTROKE.—HEAT EXHAUSTION. 67 scious. The face is flushed. The skin is in- tensely hot and dry. If the temperature of the body is taken by a thermometer it may be found as high as 1120. In ordinary fevers if the tem- perature rises to 1050 or 1060, it is considered a very severe case. This statement is made in order to strongly emphasize the fact, that the patient is suffering from an excess of heat in the body. It is exceedingly important that this ex- cess of heat should be removed as soon as possi- ble. Even minutes are valuable. Hence, the following Treatment.—Send for a physician. If the pa- tient is in a room or other place sheltered from observation, strip off all clothing. Pour cold or ice-water over the whole body from a pitch- er, or preferably, sprinkle it from a watering-pot. On the head place towels wrrung out of ice-water and frequently renewed, or cracked ice wrap- ped in a cloth. Continue this treatment until the physician arrives, or the patient begins to show signs of consciousness. If the patient is found in a public place, loosen clothing around neck, and dash cold water over face and chest. Remove as soon as possible to a retired and quiet place. Do not give stimulants. Heat Exhaustion.-—This is another but much less serious form of illness from heat. It is usu- ally caused by physical overwork during hot weather in badly-ventilated rooms. Factory o-irls are especially liable to heat exhaustion. It 68 EMERGENCY NOTES. is not true sunstroke, for the temperature of the body is very slightly elevated. It resembles fainting more than sunstroke.- By way of treat- ment nothing is required but rest in a cool room, and the giving of one or two teaspoonfuls of brandy, whiskey, or wine. Epilepsy.—The obvious symptoms of epilepsy consist of a convulsion lasting two or three min- utes, followed by a half hour or less of uncon- sciousness, which gradually passes off. The treatment consists in preventing self-injury (see section on convulsions), and in letting the patient alone during his unconscious period. SHOCK, OR COLLAPSE. This is a condition occurring to a greater or less degree in all injuries and accidents. It varies in intensity from a slight and momentary feeling of weakness, to a condition of great danger, in which the patient is cold, pale, and unconscious, with a slow and hardly perceptible pulse. Treatment.—In cases severe enough to require it, the treatment should consist principally in the application of warmth by hot bottles, etc. A small amount of stimulant may be given. POISONING. A poison is any substance which, if taken in- ternally in sufficient amount, will cause death. FOISONS.—IRRITANTS AND NARCOTICS. 69 As a matter of practical importance poisons are divided into two classes, irritants and narcotics. Irritant poisons are substances which will cor- rode and burn the skin or flesh with which they come in contact, for example, strong acids or alkalies. In other words, they destroy, to a greater or less depth, all the tissues of the body which are touched by them. The effects of an irritant poison are evident immediately after it is taken. The symptoms consist of a burning pain in the mouth, throat, stomach, and abdo- men, followed by nausea and vomiting. Faint- ness and shock are also present in varying de- grees. On the other hand, in narcotic poisoning, the symptoms come on more slowly. Take an overdose of laudanum, for example. It is a preparation of opium. After taking it, a period of fifteen to twenty minutes will elapse before any effect is perceived. The person then be- gins to be drowsy. The drowsiness gradually increases, until it results in a profound sleep or stupor, from which the patient can be aroused with difficulty, if at all. This shows the differ- ence in the two kinds of poisoning. With irritants the effects—pain, vomiting, and shock—appear immediately. With narcotics the effects—usually drowsiness and stupor, no pain—are comparatively slow in making their appearance. 7o EMERGENCY NOTES. There are some substances which have both irritant and narcotic properties in differing pro- portions. In poisoning from such substances, the symptoms are of a mixed character. TREATMENT OF POISONING. I. If you know the poison and also its antidote, give the antidote at once. An antidote is a substance which will either combine with the poison to form a harmless compound, or some- thing which will have a directly opposite effect upon the body, thus counteracting the influence of the poison. After administering the antidote the case falls under the following rules : 2. If the poison is known and its antidote has been given, or, If the antidote is not at hand and procuring it would cause delay, or, If the poison is unknown, Cause vomiting as quickly as possible, so as to remove the poison from the stomach. The means by which this may be accomplished are as follows : Stir in a tumbler of water a table- spoonful of mustard, or salt, and make the pa- tient swallow the whole. It will usually be quickly rejected, bringing the contents of the stomach with it. Two or three teaspoonfuls of the syrup of ipecac will have a similar effect. If none of these are at hand compel the patient to drink lukewarm, or even cold water until vomit- TREATMENT OF POISONING.—ANTIDOTES. 71 ing occurs. If the case is one of attempted sui- cide it may be necessary to open the mouth by force, and keep it open by inserting between the teeth a cork, or the handle of a table-knife. Then thrust the finger down the throat and hold it there until the patient vomits. After vomiting has been caused you should give to aid it, and also to protect and soothe the walls of the stomach, one or more of the follow- ing substances : Milk, uncooked white of egg stirred up in water, flour and water mixed, gruel, boiled starch, or oil. The last should not be given in phosphorus poisoning. SPECIAL POISONS AND THEIR ANTIDOTES. This list includes only the more common poisons. Acids.—Nitric, muriatic or hydrochloric, sulphuric and oxalic, excluding carbolic acid. Antidotes.—Baking soda, a teaspoonful in a cup of water. Lime-water, as much as the pa- tient can swallow. A teaspoonful of mag- nesia, whiting, chalk, tooth-powder, or lime scraped from a plastered or white-washed wall, stirred into a cup of water. A table- spoonful of strong soap-suds. Alkalies.—Lye, soft soap, various washing fluids and powders, strong ammonia, or harts- horn. 72 EMERGENCY NOTES. Antidotes.—A tablespoonful of vinegar in a cup of water. The juice of two lemons, with an equal quantity of water. The juice of two oranges may be given, if the others are not at hand. Acids and alkalies combine to form harmless salts, or, in other words, they neu- tralize each other. Oil—olive or salad, lin- seed, and castor, form harmless soaps. Arsenic.—Some rat and fly poisons. Antidote.—A preparation of iron freshly made. Send to nearest druggist for " Antidote to Arsenic." Carbolic Acid.—This is not a true acid. Antidote.—There is no chemical antidote. Give oil freely, olive or salad, linseed or castor. Iodine. —The most common preparation is the tincture, or " iodine paint." Antidote.—Boiled starch. Laundry or corn- starch, arrow-root, boiled or baked pota- toes. Lead.—Sugar of lead in some lotions and hair-dyes. Paint containing white lead. Antidote. — Epsom salts, a tablespoonful in tum- bler of water. Mercury.— The most common poisonous preparation is " corrosive sublimate," used to kill insects and as a disinfectant. Antidote.—Uncooked white of egg f^rms a com- paratively harmless chemical compound. Opium.—Common preparations ; morphine, SPECIAL POISONS AND THEIR ANTIDOTES. 73 laudanum, paregoric, many cough medicines and soothing syrups. Antidotes.—Opium poisoning is so common that it is more fully noticed here. There is no chemical antidote for opium, but strong coffee, pain, and motion counteract its effects. The patient may breathe very slowly ; the pupils or round dark centres of the eyes will be very small—the so-called " pin-hole pupil." Give with the emetic, or as soon after as possible, large quantities of strong black coffee. Keep the patient awake by forced walking. Whip the back and legs with a light cane, or a slipper, or strong twig, so as to produce a smarting pain. Dash cold water on face and chest at intervals. Finally, if the breathing becomes very slow, only five or six times per minute, perform artificial respira- tion. Phosphorus.—Some rat pastes, which have a strong odor. Matches. Antidote.—Common turpentine, which has been exposed to the air for some time, mixed with magnesia. Send to druggist. Do not give oil, as it favors the action of this poison. Silver.—Nitrate of silver, sometimes called lunar caustic. Frequently used in solution as a local application. Antidote.—Common salt. A teaspoonful in a cup of water. 74 emergency notes. TRANSPORTATION OF THE SICK AND INJURED. It is frequently necessary in small towns or country districts, to carry a sick or injured per- son some distance to a house, or a hospital where he may receive medical aid. In large cities, possessing a well-organized ambulance service, the necessity for such transportation is not so often felt. It is, however, not infre- quently required to move a sick person from room to room, or floor to floor of a house. As the same means are appropriate, whether the distance be long or short, it is thought best to describe the most approved improvised methods oi transportation. The best methods are those which disturb the patient as little as possible, thus saving his strength, and preventing further damage if he is suffering from an injury. These methods vary. The available number of bear- ers, the consciousness or unconsciousness of the patient, and his consequent ability or inability to aid his helpers, are some of the circumstances which influence the choice of methods. If Yon are Alone.—In the case of a child, it may, of course, be carried in the arms in the usual way. In an adult, i. If conscious and able to walk feebly, you may render efficient aid. Stahd, say, at his left side. Pass his left arm around your neck. Grasp his left wrist with your left hand. Then TRANSPORTATION OF THE SICK AND INJURED. 75 \hf Fig. 12. 76 EMERGENCY NOTES. pass your right arm around his waist and take hold of his right wrist, unless it or the arm be injured. In the latter case simply hold his waist. (See Fig. 12.) 2. If he is unconscious or unable to walk, prop him in a sitting posture. Kneel facing him. Place your right shoulder against the lower part of his abdomen. Pass your right arm around his legs just at, or above his knees. Let his body fall forward over your shoulder, his head and body hanging down behind you, until he is balanced on your shoulder like a sack of grain. Then rise to your feet. Your left arm will be free. If the patient is too heavy for you to handle, you must either leave him' and go for help, or wait until help arrives. If You have Help. 1. If the patient is conscious and can aid you, stand at his left side, facing your assistant, who stands on the other. Let each of you pass one arm under patient's thighs, the other under and around the small of his back. Then let the pa- tient put an arm around the neck of each of you. Raise him and proceed. (See Frontis- piece.) There are two variations of this method which should be noted. Instead of passing the arms under the pa- tient's thighs, take a handkerchief, or two hand- kerchiefs, if one is not strong enough, and tie TRANSPORTATION OF THE SICK AND INJURED, jy the ends firmly together, thus forming a ring. Grasp it on either side and let the wounded per- son sit on it, as on a round seat. This device renders your task more easy. (See Fig. 13.) The other modification is to form a so-called "ladies' chair," "sedan chair," or "dandy chair.'' You and your assistant face each other. Let each grasp his left wrist with his right hand, and then the right wrist of the other with his left hand. This also forms a seat upon which Fig. 13. the patient may sit. It is not so good a way as the others, for it gives no support to the patient's back. 2. If the patient is unconscious, let the stronger bearer stand at the patient's head, fac- ing toward the feet. Then let him pass his arms under the patient's arms from behind, and clasp his hands over the latter's chest. The other bearer stands at the patient's feet, facing forward, stoops and passes his arms under the patient's knees from the outside, letting the knees rest in the hollow of his elbows. Then lift the patient and move forward with " broken 78 EMERGENCY NOTES. step"—that is, not keeping step. This will pre- vent the patient's body swinging from side to side, as it will in the cadenced walk. (See Fig. I4-) 3. No matter what the condition of the pa- tient may be, if help and materials are at hand, you may use an improvised stretcher. A stretcher consists essentially of something upon which the patient may lie, and by which he may be carried. An improvised stretcher for two bearers may consist of a board, a window-shutter, a door. Poles may be thrust through the sleeves of two or more coats and the coats buttoned. The bearers take hold, one at each end. An improvised stretcher for four bearers may consist of a shawl, a blanket, a quilt, or a rug, upon which the patient is laid. The bearers stand, one at each corner, grasp the fabric, and raise it. At a pinch two bearers, one at each side, may answer. Personal ingenuity and resources count for much in tasks of this kind, as there are many other articles which may be utilized for such purposes. Directions for Using Stretchers.—It is best to have three bearers. Two carry the patient. The third watches and attends the injured per- son, and changes place with one of the others, when the latter is fatigued. TRANSPORTATION OF THE SICK AND INJURED. 79 i.RT Fig. 14. 8o EMERGENCY NOTES. To place the patient upon the stretcher, lay it at his head in a line with him. Do not place it at his side, for the bearers may stumble and fall over it. The two bearers, one at each side of the patient, pass their arms under his thighs and back, lift him backward over the stretcher and lay him on it. During this time, if a limb is injured, the third bearer holds and steadies it. The two bearers take hold of the stretcher, one at the head, and one at the foot, both facing in the direction they wish to go. Walk with broken step—that is, do not keep step. Carry the patient feet foremost, except in going up- hill. If a leg is broken, go feet foremost up hill, and head foremost down hill, so as to prevent the weight of the body pressing upon the limb. MATERIALS WHICH MAY BE USED FOR COM- PRESSES, DRESSINGS, AND BANDAGES. Always, if possible, use clean material, fresh from the store or laundry, and not that which is soiled by wearing or handling. This advice applies mainly to the treatment of recent wounds. The reason why is explained in the section on treatment of wounds. Of course in pressing emergencies this advice must needs be disregarded. Whether the material be clean or soiled, and especially in the latter case, wet it whenever MATERIALS FOR COMPRESSES. 81 possible in one of the antiseptic solutions of car- bolic acid, vinegar, or salt. Materials for Compresses.—One of the best is cheese cloth. It is usually not available in emergencies, because it requires a little prepa- ration before it is ready for use. But it is an excellent thing to keep on hand, and is prepared as follows : Procure two yards of cheese-cloth. Fold it loosely into a convenient-sized packet, and tie a string, also loosely, around the middle. Boil it in water, with a little washing soda add- ed, for fifteen or twenty minutes. Then rinse in clean water several times to remove the soda. Boiling makes it soft and absorbent like a sponge. Hang it up to dry, still tied, in a place free from dust. Untie it, shake it out, and fold it over and over until it is of a convenient size for laying away. Compresses, bandages, etc., are best kept in a tin box, to protect them from dust and dirt. When required for use a piece of proper size, and of eight to twelve, or more, thicknesses can be cut off with scissors. It is better to have a compress too thick and too large, than to go to the opposite extreme. In emergencies a variety of materials may be used for compresses, such as clean handker- chiefs, piece of muslin or linen, or strips of white clothing. Toilet paper, or even newspaper, torn into strips and crumpled into the shape of a small pillow, makes an excellent compress. 82 EMERGENCY NOTES. The same materials serve for making applica- tions to burns, etc. For bandages, the most common material is unbleached muslin of the cheapest grade. Bleached muslin and the higher grades are either too stiff or too thick for convenience in applying. In emergencies one of the following may be employed for bandages : Handkerchiefs used as triangular bandages, sheets, blankets, and clothing torn into squares and afterward folded into triangles. The same, torn in strips. Gar- ters, stockings, or suspenders. BANDAGES IN GENERAL. Bandages are used to retain and protect dress- ings or splints, and to make pressure upon or give support to any part of the body. There are two kinds of bandages : The tri- angular or handkerchief bandage and the roller bandage. (// is important that the various modes of band- aging should be learned and practised under the guidance of a competent person.) The triangular bandage is the most useful for emergencies, as it may be readily improvised. It is also possible to learn its use from illustra- tions and printed directions, which will be given. The roller bandage is the kind which is universally employed by physicians. It is much better and more generally useful than the tri- BANDAGES.—THE TRIANGULAR BANDAGE. 83 angular bandage. It is frequently of great ser- vice in home emergencies and surgical illness. Therefore it is well to seek personal instruction in its various modes of application. It is well- nigh impossible to obtain the necessary skill of hand from illustrations and printed directions, until at least its elementary principles have been acquired. It thus differs to some extent from the triangular bandage. THE USE OF THE TRIANGULAR BANDAGE—THE BANDAGE FOR EMERGENCIES. Take a piece of unbleached muslin varying from twenty-four to forty inches square, accord- ing to the part of the body for which it is to be used. Cut it into triangular halves, or use a large handkerchief folded into a triangle. The longest border is called the base. The corner opposite the base is termed the point, and the other corners, the angles. (See Fig. 15, X.) To fold when not in use.—Place the angles to- gether and fold on a line running from base to point (Fig. 15, X), thus (Fig. 15, Y) forming a smaller triangle, A P B. Then bring the angles A and the point P to the centre of the base B, at the end of the line made by the first folding, forming a square, F E B G. Fold the square through the line C D, forming an oblong, C D B E. Continue folding until of convenient size and shape for putting in box or pocket. 84 EMERGENCY NOTES. Q^h Ctrtjll A Y USE OF THE TRIANGULAR BANDAGE. 85 It may be used as, 1. A triangle, unfolded to its full extent. 2. A cravat, broad or narrow. Unfold it and lay it flat, base toward you. (See Fig. 15, X.) Bring point down to centre of base, folding it along the line H I. Then fold it lengthwise toward you along the line L K, twice for a broad, or three times for a narrow bandage. 3. A cord. A cravat twisted. Used as an improvised tourniquet. (See Fig. 16, left arm.) The poorest way of fastening a bandage is to tie or knot the ends. The next best way is to use pins. The best way is to fasten it with a few stitches. The pressure of the knot is sometimes painful, the pins may prick, but the stitches are open to neither of these objections. Manner of using. Broad Arm-sling.—Take a triangle. Place wrist on centre of base, point toward elbow. Pass angles around neck and tie, or pin. Fold point around elbow and pin. (See Fig. 8, left arm.) Narrow Arm-sling.—Fold like a cravat. Lay wrist on centre. Tie or pin ends around neck. Head Bandage.—Triangle. Lay base on fore- head. Carry angles round and tie at back of head. Carry point back over top of head, under knot, then forward over knot to top of head and fasten. Always place centre of triangle on the 86 EMERGENCY NOTES. Fig. 16. u*? USE OF THE TRIANGULAR BANDAGE. 87 Fig. 17. ;// 88 EMERGENCY NOTES. place which it is wished to cover. It is not so good a method as the following : Head, Face, and Chin Bandage.—Cravat. Place centre of cravat on wounded point. Carry ends around head or neck and tie. For instance, fore- head : Lay centre on forehead, tie at back of head. (See Figs. 16, 17, head.) Back of head, tie over forehead. Side of head, tie on opposite side. Top of head, tie under chin. Chin, tie on top of head. Eyes, one or both, tie at back of head. Nose and upper part of cheek, tie at back of head. Mouth, and chin just under mouth, tie at back of head, or back of neck. Neck Bandage.—Cravat around neck. (See Figs. 16, 17, neck.) Shoulder Bandage.—Two bandages, a cravat and a triangle. Tie cravat around neck. Lay centre of base of triangle on outside of shoulder or upper arm. Carry angles completely around arm and tie on outside of arm. Carry point up under cravat, then over and down to point of shoulder, where it should be fastened. (See Figs. 16, 17, right shoulder.) Arm and Forearm Bandage.—Use a cravat wound around arm at any desired point be- tween shoulder and wrist. (See Figs. 16, 17, right elbow.) Hand and Wrist Bandage.—Triangle. Lay front of wrist and palm of hand on centre of base of bandage, fingers toward point. Bring USE OF THE TRIANGULAR BANDAGE. 89 point over ends of fingers to back of wrist. Fold angles, first one then the other, over back of hand, around wrist, and tie on back of wrist. (See Figs. 16, 17, right hand.) Chest, or Back Bandage.—To cover chest. Triangle. Place centre of base on lower part of chest, point toward neck. Carry angle on each side around chest and knot on back, leaving one end of knot much longer than the other. Carry point over either shoulder and tie to long end of knot. To cover back, place centre of base on back and knot over chest. (See Figs. 16, 17, chest, over left shoulder.) Chest and Waist Bandage.—Broad cravat. Pass around chest, or waist and tie. Hip Bandage.—Narrow cravat and triangle. Tie cravat around waist. Place centre of base of triangle on outer side, upper part of thigh, point upward. Pass angles completely around thigh and knot on outside. Pass point under waist cravat, bring it down and fasten on outer side of hip. (See Figs. 16, 17, left hip.) To cover both hips use two triangles, one on each side. Thigh and Leg Bandage.—Cravat, broad or narrow. Wind around thigh or leg at any de- sired point between hip and ankle. (See Figs. 16, 17, right leg.) Foot and A nkle Bandage. —Tr iangle. Place the heel on the centre of base, toes toward point. 90 EMERGENCY NOTES. Bring point upward over toes to instep. Take angles forward, cross them on instep, pass com- pletely around ankle and tie in front over ankle. (See Figs. 16, 17, right foot.) THE ROLLER BANDAGE. The roller bandage consists usually of a long and narrow strip of unbleached muslin, rolled from one end into a cylinder, or roller. Cheese- cloth and other thin cotton fabrics are some- times used, for special cases, when some expert- ness has been acquired in its use. The dimensions of the roller bandage for different parts of the body are as follows, vary- ing according to the age and size of the subject: Part. Width. Length. Fingers ................. K'O' inch...........i yard. Arm.....................2 to 2j£ inches ....... 3 to 6 yards. Leg......................1% to 3 inches.......6 to 8 yards. Chest...................4 to 5 inches.........8 to 12 yards. Head..................2 to 1% inches.....___4 to 6 yards. The greater part of these may be prepared by tearing a piece of muslin, six yards long, into strips of the proper width, and cutting to the proper length. Selvedge edges must be re- moved, as otherwise they will cut the flesh like a string. Points which should be studied : Elements of Roller Bandaging.—Circular, spiral, and spiral reversed. The figure-of-eight, or crossed bandage for joints. ROLLER BANDAGE.—PERSONAL PRACTICE. 91 Special Bandages.—Circular bandage of the ' head and neck. Four-tailed bandage of the head and chin. (See Fig. 8, chin and head.) Figure-of-eight bandage of the shoulder. Spiral bandage of the chest. Spiral bandage of the fingers and thumb. Figure-of-eight bandage of the wrist and el- bow. Spiral reverse bandage of the arm. Figure-of-eight bandage of the ankle. Spiral reverse bandage of the leg. THINGS TO BE PERSONALLY PRACTISED AND STUDIED. On the Living Model. Location of heart. Location and course of main arteries. Points for pressure of arteries. Manner of making pressure on wounds. Preparing and applying compresses. Art of applying triangular and roller band- ages. Application of improvised tourniquet. Practice of artificial respiration. Preparing and applying improvised splints. n the Skeleton. Size, shape, and relation of bones. Joints. INDEX. TAGB Abdomen, The...................................... 41 Acids, Antidotes to............,.................... 71 '' Burns from, Treatment of..................... 51 Acid, Carbolic, Antidote............................ 72 Adult, Convulsions in, Treatment.................... 62 Alkalies, Antidotes to............................. 71,72 " Treatment of burns from ............ ..... 51 Ammonia or hartshorn, Antidotes to................. 71, 72 Ankle-bones, Treatment of fractured................ 48 Antidotes to acids................................... 71 " " alkalies................................ 71,72 " "arsenic................................. 72 " " carbolic acid.......................... 72 " " iodine................................. 72 " " lead in hair-dye and paint................ 72 "lye..................................... 71,72 " " mercury or corrosive sublimate.......... 72 " " phosphorus ........................... 73 " rat and fly poisons...................... 72,73 " "soft-soap . ........................... 7i,72 " strong ammonia or hartshorn........... 71,72 " " washing fluids......................... 71, 72 Antisepsis, What is................................. 28 Antiseptics, What are....... ...................... 29, 30 Aorta, The....................................... 14 Arsenic, Antidotes to............................... 72 94 INDEX. PAGE Arteries, The....................................... 14 " which should be studied.................... 16 Arterial bleeding, or haemorrhage.................... 17, 18 Artificial respiration................................. 55—57 Auricle, The right and left........................... 12 Bacteria, What are.................................. 28, 29 Bandages, Kinds of................................. 80 Materials for............................ 81, 82 Materials which may be used as........... 46 Bandage, Use of the roller.......................... 90 " " " " triangular...................... 83 Bleeders, Families of............................... 20 Bleeding, Arterial, venous, and capillary ............. 17 " from the gums, Treatment of.............. 36 " " lungs, Treatment of............... 37 " " nose, Treatment of............... 35 " ruptured vein, Treatment of........... 23 " severe wounds, Character of.......... 17 " slight wounds, Character of............ 17 " the stomach, Treatment of............ 37 " wounds of the body.................. 23 " in general, Treatment of...... 30 " Means for stopping....................... 20 '' Stimulants in............................. 24 Blood, Circulation of the............................ 9 Clotting of the................'.............. 18, 19 '' The color of................................. 14 " " course of ............................... 15 Blood-vessels, The.................................. 14 Body, Bleeding from wounds of the.................. 23 Bones, The......................................... 38 Bruises, Nature of................................... 25 " Treatment of............................... 31 Burns, Degrees of................................... 50 " from acids, Treatment of...................... 51 " " alkalies, Treatment of.................... 51 INDEX. 95 PAGE Burns from caustic, Treatment of.................... 51 " Treatment of................................. rj Callus............................................. 43 Capillaries, The................................... 14 Carbolic acid, Antidotes to ......................... 72 " " Solution of, as an antiseptic............ 30 Carrying the sick and injured........................ 74 Cartilage........................................... 40 Capillary bleeding, or haemonrhage.................... 17, 20 Causes of fainting.................................. 65 " " unconsciousness..................... .... 64 Caustic, Burns from, Treatment..................... 51 " Lunar, Antidote to....................,..... 73 Child, Treatment of convulsions in a................. 63 Choking, Treatment of.............................. 60 Circulation of the blood............................9, 15, 16 Clavicle, The......................................, 42 Clotting of the blood............................... 18, 19 Cold and heat as a means for stopping bleeding....... 21 Collapse, Treatment of............................. 68 Collar-bone, The.................................... 40 Treatment of fracture of................. 46 Compound fracture, Serious nature of............... 45 Compresses, Materials for........................... 80, 81 Contusions, Nature of.............................. 25 Treatment of............................ 31 Convulsions in adult, Treatment of................... 62 " child, Treatment of.................. 63 Corrosive sublimate, Antidote to..................... 72 as a germicide.................. 29 Cough medicines, Treatment of poisoning by.......... 73 Course of the blood................................. 15 Croup, Treatment of..........................,..... 64 Degrees of burns.................................. 50 Diaphragm, The.................................... 41 96 index. PAGE Dislocations, Treatment of.......................... 48 Drowning, Advice if in danger of.................... 53 Artificial respiration in... ................ 55—57 " Treatment of............................. 53 Ear, Foreign bodies in, Treatment.... .............. 62 " Insects in, Treatment........................ 62 Enlarged (varicose) vein, Treatment of bleeding from an........................................... 23 Epilepsy, Treatment of.............................. 68 Exhaustion from heat, Treatment of................. 67 Extremities, The................................... 42 Eye, Caustic particles in, lime, acids, mortar, Treat- ment..................................... 61,62 " Particles in, Treatment........................ 61 Fainting, Causes and treatment of.................... 65, 66 Femur, The........................................ 42 Fibula, The........................................ 42 Fly and rat poisons, Antidotes to.................... 72, 73 Forearm bones, The................................. 42 " Treatment of fracture of ............ 49 Foreign bodies in ear, Treatment of.................. 62 " " eye, Treatment of.................. 61 " " nose, Treatment of................. 62 " " " throat, Treatment of............... 60 Fractures in general........ ...................... 40 Healing of........................... ... 43 Temporary treatment of.................. 45 Fracture, Serious nature of a compound.............. 45 " Setting a.............................. 44 Signs of................................. 43 of collar-bone, Treatment ................ 46 " forearm and wrist-bones, Treatment..... 49 '' jaw-bone, Treatment.................... 46 " leg and ankle-bones, Treatment......... 48 " ribs, Treatment........................ 48 INDEX. 97 I'AGR Fracture of thigh-bone, Treatment.................. 48 " upper arm-bone, Treatment............. 46 Frost-bites, Treatment............................. 52 Gas, Suffocation from, Treatment.................... 59 Germicides ? What are............................. 29 Germs ? What &re.................................. 28, 29 Granulation, Healing of wounds by................... 25 Gums, Treatment of bleeding from................... 36 Haemorrhage, Arterial, venous, and capillary........... 17 from ruptured vein, Treatment of..... 23 " " severe wounds. Character of....... 17 " slight wounds, Character of....... 17 " the gums, Treatment of........... 36 " " lungs, Treatment of............ 37 " " nose, Treatment of............ 35 " " " stomach, Treatment of......... 37 " wounds of the body................ 23 " in general, Treatment of... 17,30 Means for stopping.................... 20 Stimulants in.......................... 24 Hartshorn or strong ammonia. Antidotes to.......... 71,72 Head, The bones of the.............................. 40 Healing of fractures............................... 43 " " wounds................... -............. 25 Heart, The ....................................... 12 Valves of.................................... 15 Heat and cold as a means for stopping bleeding....... 21 " exhaustion, Treatment of....................... 67 Humerus, The...................................... 42 Hydrochloric acid, Antidotes to.................... 71 Improvised stretchers............................. /S tourniquet.............................. 22 Incised wounds, Nature of........................ 24 Injured, Transportation or carrying of lhe............ 74 98 INDEX. PAGE Insects, Treatment of stings of....................... 34 Intention, Healing of wounds by first................ 25 Iodine tincture or paint, Antidote to.................. 72 Irritant poisons..................................... 69 Jaw-bone, Treatment of fracture of................... 46 Joints, The, kinds of............................... 42 Knee-cap, The........................-............ 42 Lacerated wounds, Nature of........................ 24 Laudanum, Treatment of poisoning by............... 73 Lead in hair dyes, Sugar of, Antidote to.............. 72 " White, in paint, Antidote...................... 72 Leg-bones, The..................................... 42 " Treatment of fracture of.................. 48 Lesser circulation.................................. 15 Ligaments, The .................................. 42 Limbs, The....................................... 42 Lunar caustic, Antidote to.......................... 73 Lungs, Treatment of bleeding from.................. 37 Lye, Antidotes to................................... 71, 72 Matches, Phosphorus poisoning by, Treatment........ 72 Materials for compresses and bandages............... 80 " which may be used as splints............... 46 Means for stopping bleeding or haemorrhage.......... 20, 30 Mercury, Antidote to.............................. 72 Morphine, Treatment of poisoning by................ 73 Muriatic acid, Antidotes to......................... 71 Muscles, Action of.................................. 9 Narcotic poisons.................................... 69 Nitric acid, Antidotes to............................. 71 Nose, Foreign bodies in, Treatment of................ 62 " Treatment of bleeding from................... 35 INDEX. 99 PAGE Opium-poisoning. Treatment of...................... 73 Oxalic acid, Antidotes to........................... 71 Padding for splints, What may be used as ............ 46 Paregoric, Treatment of poisoning by................ 73 Patella, The....................................... 42 Pelvis, The....................................... 42 Phosphorus-poisoning, Treatment of................. 73 Poisons, Irritant.................................. 69 " Narcotic................................... 69 " their antidotes............................. 71 Poisoning, Treatment of............................ 68, 70 by acids................................. 71 " " alkalies.............................. 71 " ammonia............................. 71 '' arsenic............................ 7,2 " " carbolic acid.......................... 72 " corrosive sublimate................... 72 " hartshorn........................... 71 " " laudanum............................ 73 " lead................................. 70 " lye................................. 71 " lunar caustic......................... 73 '' morphine............................ 73 " nitrate of silver........ ............. 73 " opium............................... 73 " " paregoric ...............'•"•......... 73 " " phosphorus, Treatment of.............. 73 " rat and fly poisons.................... 72,73 " " soft-soap............................. 71 " " soothing syrup or cough mixture....... 73 Pressure as a means of stopping bleeding............. 22 Primary union of wounds........................... 25 Pulmonary circulation.............................. 15 Radius, The........................................ 4" Rat and fly poisons, Antidotes to..................... 72, 73 IOO INDEX. PAGE Respiration, Artificial............................... 55—57 Ribs, The.......................................... 4' " Treatment of fractured........................ 48 Scalds, Treatment of................................ 51 Scapula, The....................................... 42 Secondary union or granulation, Healing of wounds by 25 Setting a fracture................................... 44 Shock, Treatment of................................ 68 Shoulder-blade, The................................ 42 Sick, Transportation or carrying of the .............. 74 Silver, Nitrate of, or lunar caustic, Antidote........... 73 Skeleton, The...................................... 38 Soap, Antidote to.................................. 7*. 72 Soothing syrups, Treatment of poisoning by.......... 73 Spine, The......................................... 40 Splints, Materials which may be used as............. 45. 4° Sprains, Treatment of............................... 49 Sternum, The............................... ...... 41 Stomach. Treatment of bleeding from the............. 37 Stopping bleeding or haemorrhage, Means for......... 20, 30 Stretchers, Improvised................... .......... 78 Suffocation from gas, Treatment of................... 59 Sulphuric acid, Antidote to.......................... 71 Sunstroke, Treatment of............................ 66, 67 Systemic circulation................................ 15, IO Tendon, what is it ?................................. 10 Thigh-bone, The................................... 42 Treatment of fractured................. 48 Throat, Treatment of foreign bodies in............... 60 Tibia, The......................................... 4« Tourniquet, Improvised............................. 22 Transportation of sick and injured................... 74 Treatment of bleeding from a ruptured vein.......... 23 " " " " the gums................ 36 " " " lungs................ 37 INDEX. 101 PAGE Treatment of bleeding from the nose................ 35 " " " " stomach............. 37 " burns................................ 51 " " from acids...................... 51 " " " " alkalies.................... 51 " " choking.............................. 60 '' collapse. ............................ 68 " contusions or bruises.................. 31 " " convulsions in adult................... 62 " " " " child................... 63 " croup................................. 64 " dislocations................'.......... 48 " epilepsy.............................. 68 " fainting.............................. 66 " foreign bodies in ear ................. 62 " " " " eye.................. 61 " " " " " nose................. 62 " " " " throat............... 60 " fracture of collarbone................. 46 " " " forearm and wrist-bones.... 48 " " jaw-bone.................. 46 " " " " leg and ankle-bones........ 48 " " " " upper arm-bone............ 46 " " fractured ribs............. ........... 48 " " " thigh-bone................. 48 " " frost-bites............................ 52 " heat exhaustion....................... 67 " insects in ear ........................ 62 " opium-poisoning..................... 73 " phosphorus-poisoning................. 73 " poisoned wounds............ ........ 32 " poisoning........................ .... 70 " scalds................................ 51 " " shock................................ 68 " " sprains.............................. 49 " " stings of insects....................... 34 " " suffocation from gas................... 59 102 INDEX. PAGE Treatment of sunstroke........................... 67 " the apparently drowned............... 56 " unconsciousness in general............ 65 " wounds and bleeding from them, Rules for the............................ 30 Trunk, The....................................... 40 Ulna, The.......................................... 42 Unconsciousness, General treatment of.............. 65 Union or granulation, Healing of wounds by secondary. 25 Union, Primary, of wounds.......................... 25 Upper arm-bone, The............................... 42 Treatment of fracture of............ 46 Valves of th^e heart.................................. 15 " ' * " veins................................. 14 Vein, Bleeding from a ruptured, Treatment of......... 22 Veins, The........................................ 14 Venous bleeding, or haemorrhage...................17,20,23 Ventricle, The right and left ........................ 12 Vertebra, A........................................ 40 Vinegar as an antiseptic............................. 30 " a styptic................................. 21 Voluntary muscles................................. 10 Washing fluids, Antidotes to ...................... 71,72 Wrist-bones, Treatment of fracture of................ 48 Wounds, bleeding from them, Rules for treatment of... 30 " Importance of cleanliness in................ 28 " Kinds of, and mode of healing.............. 24 of the body, Bleeding from............... 23 Poisoned, Treatment of.................... 32 Severe, Character of bleeding from.......... 17 " Slight, Character of bleeding from........... 17 " Time required for healing in................ 27 WA B985e 1889 62921260R NLM DSlETflfl? 0 NATIONAL LIBRARY OF MEDICINE NLM051298870