SCARCELY a month passes by, to many persons, without meeting somewhere an accident or an emergency in which a little reliable information is not of the greatest service. One of the difficulties usually to be contended against in such cases is, loss on the part of the bystanders to know just what should be done. It will be found, as a rule, that the simplest things, usually the most useful, are neglected, while there is a disposition to rely upon cumbrous appliances, often of disadvantage, and sometimes positively hurt- ful. The object of the writer of this pamphlet is to present in a compressed form, for easy recollection and ready reference, a few . suggestions as to what should be done in certain cases of emer- gency, until the arrival of skilled professional assistance. It is not saying too much, perhaps, that what is to be done to give re- lief or save life, in the greater number of cases, must be done by some one else before the aid of a physician can be procured. It has been truly said, "for want of timely care, millions have died of medicable wounds." As far as possible, the use of technical terms will be omitted, although where necessary they will be used, with a brief definition inclosed in brackets; but the writer would respectfully suggest, that, whenever possible, the scientific terms should be remembered and used, instead of the popular expressions for the same thing. A scientific term, the world over, means but one thing; while a po- pular expression, in one place, means one thing, and in another, two or three things; and, possibly, nothing at all. 6 ACCIDENTS—l:Mt;&Gl!NCIKg—I>01SoNa. ACCIDENTS IN GENERAL. An accident anywhere, if there are people about, assembles a crowd around the victim. The first thing to be done is to dis- perse it; or, at least, get the people to keep away from the injur- ed person. A space of at least ten feet on every sMe should be kept wholly free from everybody except one or two in charge of the operations for relief. If others are needed for a moment, to assist in some special duty, as lifting, removing of dress, etc., they can be specially selected from the crowd; and, having been of service, can immediately return where they came from. In se- veral instances, the writer has seen a person just removed from water,, or gas, so closely surrounded by a dense mass of "rela- tives" and "friends," that it was impossible for the physician to freely use his arms. The kindest thing a bystander can do, is to insist upon a free space as large as suggested, and select from the crowd persons to hold themselves in readiness to start for what- ever the physician or the individual in charge of the case may re- quire. To show how little real interest the inside layer of the crowd usually takes in the restoration of the patient, it will often be found that it is almost impossible to get one of them to run an errand in the interest of the sufferer. If the person has been thrown from a carriage, injured by a fall from a height, blow or other cause; while there may be no frac- ture or other external injury evident, the nervous system has re- ceived what is called a "shock." As is commonly said, the per- son is "faint." A person suffering with such symptoms should, if possible, be placed flat on the back, with the head, neck, and shoulders slightly raised. The limbs, at the same time, should be straighten- ed out, if practicable; so that the heart, already depressed in ac- tion, may act' at as little disadvantage as possible. The cravat, col- lar, and every thing else calculated to in any way impede the cir- culation toward the head, or the movements of the chest, should be loosened or removed. If the injury is slight, reaction will soon ACCIDENTS—EMEEOENCIES—POISONS. 7 come on after giving the person a sip of cold water; brandy and water (tea-spoonful in a table-spoonful of cold water every couple of minutes); or Aromatic Spirits of Ammonia (twenty drops in a table-spoonful of cold water) every couple of minutes. Gentle frictions to the extremities, a few drops of cologne-water on a handkerchief to the nostrils; if the weather is hot, the use of a palm-leaf fan; hot flannels to the limbs and epigastrium (pit of the stomach); are all likewise useful in assisting reaction. By this time, should a surgeon have arrived, he will examine and decide upon the special nature of tlie injury, and inaugurate . measures of special relief. Should he not have appeared, and it is thought best to remove the patient to the hospital, or his home, a stretcher should be secured, or a substitute, in the shape of a settee or shutter, provided. The injured person should then be gently slipped on, seeing that the body is supported as much as possible along its length, something thrown over or held over the face, to prevent, as much as practicable, the uncomfortable feeling of being stared at in passing along. Four persons of uniform gait should then gently lift the stretcher and slowly carry the person to his destination. In most cities, appliances for carrying injured persons are required to be kept at the station-houses, and can be obtained, on application, as well as the services of a good policeman. The authority of the latter is almost invaluable in keeping away the crowd referred to, and in securing useful atten- tion in conveying the person through the streets. If the person is to be taken to the hospital, a dispatch from a police-station will secure from most of them, free of charge, an ambulance, with competent persons to take charge of the injured individual. Directions for fractures and dislocations are given elsewhere, p. 34. ASPHYXIA. This commonly-used word is from the Greek, signifying an ab- sence of pulse. It states a fact, but not the cause. Like many other old words, the original meaning has been set aside, and it 8 ACCIDENTS——EMERGENCIES——POISONS. now means suspended animation, produced by the non-conversion of the venous blood in the lunga into arterial. The supply of good air to the lungs being cut off by some cause, the necessary purification at that point no longer takes place, and death of the entire body ensues from the absence of arterial blood, or the pre. sence of venous blood; some physiologists regarding it from one cause, others from the other. In other words, as is often said; the person dies because the blood is not purified. It will be seen there can be several varieties of Asphyxia, as (1) Asphyxia from submersion, as in the ordinary drowning in water or other fluids; (2) Asphyxia from mechanical causes, as by strangulation, or hanging, and by foreign bodies in the windpipe or its approaches; (3) Asphyxia by inhalation of gases, known as suffocation; (4) Asphyxia from torpor of the medulla oblongata (an important portion of the brain, at the junction of the spinal cord and what is called the brain), produced by the introduction into the blood of certain poisons. Browning'. As said above, this is Asphyxia from submersion in water or other fluids. This accident is of such frequent occurrence, and what is to be done must be done so quickly, that it is the duty of every member of the community to understand the measures of relief in such cases.* The body should be recovered as soon as possible from the wa- ter; the face turned downward for a moment, with the forefinger of a bystander slightly curved and thurst backward, to depress the tongue, to favor the escape of a small quantity of water or
*A series of brief and easily understood " Directions for Restor- ing the Apparently Drowned," have been prepared and printed in large type, on cards suitable for hanging. Responsible individuals willing to personally undertake the placing of them at ferry-slips, bridge-approaches, boat-houses, and such places, will be gratuitously furnished with cards, on application to the Howard Hospital and Infirmary for Incurables, 15,18 and 20 Lombard street, Philadelphia. ACCIDENTS—EMERGENCIES——POISONS. 9 mucus, or other substances, often collected at the base of the tongue, over the entrance to the trachea (windpipe), which tends to obstruct the entrance of air to the lungs. The barbarous prac- tice of rolling the person over a barrel, or hanging him head downward, to permit the escape of water from the lungs, has al- most ceased, in view of the fact, now generally known, that no water can get into the lungs. This can be done as tlie body is being conveyed to the nearest house, a messenger having been previously dispatched to make the arrangements involved in the following: As soon as the body arrives, it should bo stripped of the clothing, rapidly dried, placed on a bed, previously warmed, tlic liead, neck, and shoulders raised a very little, if any; frictions with the dry hands used to tlie extremities, and heated flannels kept applied to the rest of the body. For an instant imagine the condition of affairs. Each atom of the body requires arterial blood, which is blood purified in the lun"-s by exposure to tlie air breathed. The purification has been suspended, and to that extent tlie life of the body is suspended. Movements of the chest, by which air is inhaled, are at a stand- still, and can not, of themselves, be resumed. If artificial breathing can be carried out for some time, it will be seen that these impu- rities may be so far removed tliat natural respiration can take place. Two methods are usually employed for the purpose—the first known as "Sylvester's Ready Method." This consists, after the above suggestions have been carried out, in pulling the tongue forward which better favors the passage of air along the base of the tongue into the trachea (windpipe), and then drawing the arms away from the sides of the body and up- ward, so as to meet over the head, by means of which the ribs are raised (expansion of the chest) by the muscles (pectoral) running from them to the arms near the shoulder. A vacuum is thus created in the lungs, the air rushes in, and the blood then is puri- fied by the passage of the impure gases in the blood-vessels to the 10 ACCIDENTS—EMEBGBKCTES—I-OISONS. air, and by the giving up by the air of a portion of its oxygen to the blood. The arms are now brought down to the sides, and the elbows made to almost meet over what is called the "pit of the stomach." This produces contraction of the walls of tlie chest, and expulsion of the impure air from the lungs. These two movements constitute an act of respiration, and should be persisted in, without interruption, at tlie rate of about sixteen to the minute. In other words, each complete movement should occupy about four seconds, which is about the natural rate of respiration in health. The second "Ready Method," ag it is called, is that of Marshall Hall. The person whose breathing is to be restored is placed flat on the face, gentle pressure is then made on the back, the pressure removed, the body turned on its side, or a little beyond that. The body is then turned again on the face, gentle pressure again used to the back, then turned on the side. This should be done about sixteen times in a minute. Both of these methods have the same object in view; either may be exclusively used, or one may be alternated with the other. Most physicians express a preference for tlie first described ACCIDENTS——EMERGENCIES——POISONS. 11 ("Ready Method of Silvester.") Both of these procedures might be practiced, in advance, by the reader, because such practice might be more easily remembered than a concise rule. The appli- cation of the tourniquet, or pressure of the fingers, described else- where, to a blood-vessel, might also be practiced at the same time. There are few people in an ordinary life, who will not find know- ledge of this kind, at their fingers' end, of the greatest use. In speaking of the restoration of persons drowned, it is often said that he was a good swimmer, and must have been attacked with "cramp." This is a spasmodic contraction of the muscles beyond the control of the individual, and occurs after exhaustion of Hie muscles from over-exertion. Persons suffering from debi- lity, especially the debility peculiarly affecting the nervous sys- tem, should never be induced to go beyond depth in the water, or out of reach of immediate assistance. There is no warning in ad- vance of the seizure, and the person sinks at once. Many lives are lost each season, in shallow as well as in deep water, from these seizures, which could have been avoided had the bather, perliaps just recovering from an attack of sickness, or even of in- disposition, not neglected the precautions stated. Recovery from Asphyxia from drowning can scarcely'be expect- ed to take place after an immersion of five or six minutes, although there are well-authenticated cases where restoration has taken place after an immersion of as much as twenty minutes. The effort ought to be made, and persisted in until the arrival of a physician, or for at least a couple of hours. As soon as returnmg vitality permits, a few drops of brandy, in a little water, may be given; and, as the strength of the person is usually completely exhausted, from muscular efforts of tlie most violent and conti- nued character, to save himself from drowning, some beef-tea, or other easily-digested nourishment, should be given. Hanging. Here death results from Asphyxia induced by pressure applied to the trachea (windpipe) from the outside, as in strangling, or 12 ACCIDENTS—EMERGENCIES—POISONS. hanging. The body, if hanging, should be at once cut down, tak- ing care not to let it fall, so as to complicate the trouble. If the knot can be untied readily, it should be done; if not, cut the liga- ture. Remove, by the finger, as in directions in drowning, any accumulation of mucus at the base of tlie tongue, place the body on the back, just as directed for a person taken from the water. If the body is still inarm, after removal of the clothing, the face, head, neck and chest should be dashed freely with cold water. To do this successfully, a person should stand off six feet, or even more, with a bowl of cold water, and then tlirow its contents, with as much force as possible, against the person. After using for a suitable length of time, tlie water should then be rapidly wiped off with a towel. Tlierc is little difference in essential features, after removal of the ligature from the neck, in the con- dition of a person who has been hanged or who has been drowned. In both it is Asphyxia : in one case, the air was kept from the lungs by a ligature; in the other, by a liquid. Artificial respira- tion in both of them must be used, assisted for the same reason, and in the same manner, by like auxiliaries. There is an impression, quite prevalent among the ignorant, that a penalty is incurred at law for cutting down the body of a person found hanging, unless the sanction of tlie coroner is ob- tained. No such delay is necessary nor even justifiable; and an effort should at once be made to restore suspended animation by the methods given. Suffocation. There are several gases, which, when inhaled, are followed by symptoms of Asphyxia. The little valve (epiglottis) over tlie en- trance of the trachea ("windpipe"), is so extremely sensitive that it will not even permit a drop of water to pass without a spasmodic closure of the opening, followed by coughing. It is not only sensitive to solids and liquids, but also to the presence of most gases. At one time it was thought that all gases were taken past it into the lungs, and absorbed from thence into the blood. The ACCIDENTS——EMERGENCIES— -POISONS. 13 opinion now seems to prevail that most of them irritate the valve spoken of at the entrance of the trachea (windpipe), and closure of the entrance follows. The breathing is thus interrupted much as it is in drowning, where the liquid cuts off the passage of air to the lungs; or as in hanging, where the ligature prevents the en- trance of air. In such cases, death results from Asphyxia. Carbonic Acid Gas. Asphyxia, by inhalation of gas, takes place as soon as the per- son comes within the influence of this compound, and takes it in with the breath. A sudden sense of suffocation is felt, with dizzi- ness of the brain and inability to stand. If a person is stand- ing at the time the air is taken into the lungs, and falls over, he is in a position, while down, to inhale more of the carbonic acid gas, for, being heavier than the air, much more of it is to be ex- perienced at the bottom of the well, or cavern, than five feet higher up. This gas, sometimes known under the name of "Choke Damp," is produced in the ordinary process of fermentation, in burning and slacking lime; and it is also found in mines, particularly coal- mines; and in wells, cellars, or caves which have been long closed up. It is considerably heavier than the atmosphere, and is con- sequently found lying on the floor of the cavity where confined. No well, vat, old cellar, or cavern of any kind, should ever be entered without first lowering down into the deepest point a lighted candle. If the flame is extinguished, or burns dimly, indi- cating the presence of this gas, no one, under any circumstances, should be permitted to enter without removing this foul air. It lies at the bottom, because too heavy to ascend. It is not so heavy, however, that a strong current of common air will not dislodge it. Buckets of water dashed down into the well, or masses of lighted shavings or blazing paper, give enough movement to the carbonic acid gas to dislodge it from its resting-place. After testing the success of the effort by again introducing the lighted 14 ACCIDENTS——EMERGENCIES——POISONS. caudle, it can soon be known whether a person may enter with impunity. Freshly-slacked lime also rapidly absorbs it. Often there may be no snch gas shown in the comity, but tho efforts of the workmen will dislodge it from an adjacent space into tlie one in which he is breathing. This possibility should never be lost sight of. When a person appears overcome by this Carbonic Acid gas, he is, of course, wholly unable to help himself, and he must at once be removed by another. Sometimes a grapnel-hook can be used with advantage, but often the better way is to rapidly lower some bold, clear-headed person, with a rope securely fastened around his middle, who can seize and bring to the surface the un. fortunate individual. No time should be lost in descending or arising, as the person lowered depends upon doing every thing during the interval he can hold his breath; for, of course should he inhale the gas, his position, in this respect, would be but little better than the man he attempts to succor. A large sack is some- times thrown over the head and shoulders of the person who de- scends. It contains enough air to serve for several inhalations, while the texture of the material prevents, to a hurtful degree, the admission of the deleterious gas. The person suffering from Asphyxia from the gas, immediately after being brought out, should be placed on his back, the neck and throat bared, and any other obstacles to the breathing quickly removed. His body should then be quickly stripped, and if he has not fallen into water on being overpowered by the gas, his head, neck, and shoulders should be freely dashed with cold water. Remember, this is not "sprinkling," as commonly practiced; but, as said before, a person should stand off some distance, with a bowl of cold water, and throw its contents, with as much force as possible, against the parts. Others should follow without an inter- val for half a minute, while one can count thirty slowly, then the dripping water wiped away by a towel. This procedure should be repeated from time to time. as apparently required. Soma-