ACCIDENTS—EMERGENCIES—POISONS. ' 15 times, if a brook of water is near, the stripped person might be dipped again and again; being careful, of course, not to dip in his face. Artificial respiration should be used with as little intermis- sion as possible. Should the person have fallen in water and become chilled, the use of the cold water, in this manner, had better be avoided, as the evaporation of the moisture absorbs more heat than can be manufactured by the exhausted and overpowered system. In such a case, the body of the person should be put into a warmed bed, with hat applications, and Artificial Respiration (p. 10) at once establislied, as in the Asphyxia from drowning and hanging. "While artificial respiration is being used, friction applied to the limbs should be kept up. Burning Charcoal. Certain gases (Carbonic Oxide Gas) of a very poisonous char- acter, are given off during the burning of charcoal, and when in- haled for a sufficient length of time, rapidly prove fatal. The person quickly drops insensible, and dies of Asphyxia in many respects like the person who has succumbed to the Carbonic Acid Gas, just described. The treatment there advised should at once be carried out. Anthracite and Bituminous Coal. These also, wlien burned in a close room, as a kitchen shut up for the night with an open stove of these burning coals, give off, to a degree, the peculiar poisonous gas alluded to as coming from burning charcoal; Carbonic Oxide Gas; as well as other noxious gases. Persons sleeping in such a room, under the circumstances, unless awakened as the air becomes fouled, will be found sense- less or dead, soon after. The treatment should be as described in the preceding pages, in Asphyxia from inhaling Carbonic Acid Gas. Common Burning' (xas. Persons retiring at night often leave the gas "turned doTTi?.,'' aa^ the flame becomes extinguished. Enough gas often escapes 16 ' ACCIDENTS—EMERGENCIES——POISONS. to give trouble to the sleeper unless the room is well ventilated. Persons have been known to " blow it out" as they would a can- dle, and suffocation more or less complete has followed. Treat as in the Asphyxia from other gases just described. Foreign Bodies In the Throat. A piece of food or some other body often gets back into the mouth, and can not be swallowed. In such a case, the finger will often be able to thrust it downward, should that be thought best. A hair-pin, straightened and bent at the extremity, will often drag it out. If the body is firm in character, a pair of scissors, separated at the rivet, and one blade held by the point, will fur- nish a loop, which often can be made to extract it. Foul Air in Drains and Privies. This is usually Sulphureted Hydrogen, and arises from the de- composition of the residual matters usually found there. Great caution, on this account, should always be observed on opening and entering such places, or places in possible communication with them, especially if they have been long closed. A small quantity of pure Sulphureted Hydrogen, if inhaled, is usually fatal; but, in the cases referred to, the gas usually exists diluted with com- mon air. The breathing becomes difficult, the person loses his strength, falls, becomes insensible and cold, lips and face blue, and the mouth covered with a bloody mucous secretion. The person should be removed as quickly as possible beyond Ihe influence of the foul air, and the treatment under the head of "Carbonic Acid Gas" pursued. The possibility of such a disaster should always be borne in mind in opening long-closed drains or privy-vaults, and the dan- ger lessened by taking a few pounds of chloride of lime (bleach- ing salt) dissolving it in a pailful of water, and dashing it into the cavity. In the absence of this, lime and water, in the form of the common " wbi'tewasV may be employed. This gas readily ACCIDENTS—EMEROENCIES—POISONS. Vl comoines with lime; to that extent freeing the air of the poison- ous compound. SUNSTROKE. Ordinary exhaustion, from overwork in a heated atmosphere, is about the only disorder likely to be confounded with sunstroke. In directions for popular use, like these, the distinction between the two will not be attempted, as there is no essential difference in the treatment. Contrary to what is generally supposed, exposure of the head to the direct rays of the sun is not necessary, as statistics show it oc- curs in the shade, under shelter, and even at night; sometimes, even in persons who have not been exposed to the sun for days be- fore. Intense heat always appears necessary to produce it; but the heat need not be solar, but may be artificial. Workmen in sugar refineries and laundries have been attacked. Sunstroke appears to be decidedly favored by intemperance; want of acclimatization; and the debility which lias been brought on by fatigue in a heated atmosphere, also favors it. Occupants of badly-ventilated sleeping apartments appear to be oftener at- tacked than those who sleep in purer air. Symptoms.—It is generally thought by the non-professional that the symptoms of sunstroke come on without any warning whatever. Most cases, however, are preceded by pain in the head; wandering of the thoughts, or an inability to think at all; disturbed vision; irritability of temper; sense of pain or weight at the pit of the stomach; inability to breathe with the usual ease and satisfaction. These symptoms become more marked until insensi- bility is reached, sometimes preceded by delirium. The skin is very hot, usually dry, but when not dry, covered with profuse perspiration. The face is dusky, or, as the saying is, "blue;" breathing, rapid and short, or slow and sighing. The action of the heart, indicated to the hand placed over it, is weak, rapid, and tremulous, often compared to the "fluttering of a bird." In many instances, from what is popularly termed the 18 ACCIDENTS——EMERGENCIES—POISONS. commencement of the attack until it ends in death, the patient does not move a limb, nor even an eyelid. The breathing gradually fails; the blood, therefore, is not puri- fied in the lungs, as is indicated by the livid, purplish appearance of the surface. We are led by it to conclude that death takes place by Asphyxia, as described under the heads, "Drowning," "Suffocation," etc., pp. 10-12. Causes.—"While we know certain things favor the disorder; that a high temperature is necessary to produce it; and advise certain measures of precaution and relief, found by experience useful in such cases; but little is known of the nature of the malady. It would seem that the great heat of the body induces some change in the character of the blood, disqualifying it for the usual pur- poses of blood. From this peculiar condition of the blood, the portions of the brain or nervous system controlling the action of the muscles of the chest and heart lose their ability to superintend properly the movements of breathing and circulation, and, as said before, the person dies from Asphyxia. Treatment.—The person attacked should at once be carried to a cool, airy spot, in the shadow of a wall, or to a large room in a house with a bare floor; or, what is often better, if there is no sun, he should be placed in a backyard, on the pavement. Un- necessary bystanders must be kept at a distance, as the person in this, as in every other accident, needs all the pure air about. The clothing should be at once and gently removed, and the patient placed on his back, with his head raised a couple of inches by a folded garment. Then the entire body, particularly the head and chest, dashed with cold water, in profusion. While preparations are being made for this, a messenger should be dis- patched for a good supply of ice. A large fragment should be placed in a towel, and struck a few times against the side of the house to rapidly reduce it to small pieces. These pieces, mixed by the hand into a bucket of water, will rapidly supply ice-water. Two buckets can be used, each half full of the small ice, and as ACCIDENTS—EMERGENCIES—POISONS. 19 soon as the water of one is used for dashing against the patient, another will be ready for the same purpose. The ice-water must not be sprinkled over the person, but dashed against him in large bowlfuls, particularly against the head and chest. While one person makes the ice-water, and another uses it, a third should, in the same manner, with a towel, break some ice in fragments not larger than almonds. A double handful, at least, of these bits should be placed in a thin, coarse towel, the ends gathered up and fastened with a string, as you would a pudding. Then holding to the tied portion of the collection of ice, the entire surface of the body should be rapidly ruWed. Indeed, two other persons might, each at the same time, be engaged at different portions of the body—not forgetting the head. These measures are to reduce the heat of the body from the high temperature, evident even to the hand of a bystander, to some- thing like a natural temperature. When the decline in the heat is noticed, the cold applications should be abandoned, the patient carefully removed to a dry spot, and the entire surface of the body dried off with towels. Should a tendency to a return of the high temperature be seen, as sometimes happens, even after consciousness is restored, it must be met by a renewal of the cold applications. The rise again in tempera- ture need not seem surprising, when the amount of highly heated blood within the body, not yet exposed to the cold applications, is taken into consideration. Artificial respiration, until the natural returns, must be resorted to as soon as the heated condition of the body is overcome. The dashing of cold water over the chest and face is a useful means of encouraging a return of the suspended breathing, and is practiced in asphyxia from other causes (page 14). The Ready Methods of p. 11, however, had better be relied on for this purpose. Medicines in this malady, it will be seen, can be of little value. A stimulant, however, may be useful. Brandy, or any other fonn of alcohol, should be carefully avoided. The best stimulant in 20 ACCIDENTS——EMERGENCIES——POISONS. all such cases, if it can be obtained, is the Aromatic Spirit of Am- monia;* fifteen or twenty drops in a tahle-spoonful of water, might be given, every few minutes, until taken three or four times. Prevention,.— During the heated term, as it is called, all use whatever of malt, fermented, or distilled drinks should be ab- stained from. Not only do they favor, in a general way, a condi- tion of the system in many respects similar to that which leads to sunstroke, but they deaden sensibility at the very time it ought to be on the alert; and the person is less able to detect slight changes in his feelings, which otherwise might have served as useful warnings in his behalf. The use of such substances, under the circumstances, seems as unwise as it would be for a person, in a time of great danger, to prepare for watchfulness by taking a dose of laudanum; or for a worker with his hands among hot metal to apply something to them by which sensibility would be dead- ened or destroyed. By night, perhaps, he would have no fin- gers left. .Every thing in any way calculated to impair the strength should be avoided. Sleep is a most wonderful restorer of strength, and the want of it is often caused by a badly-assorted late meal of the evening before. Defective ventilation leads to a condition of affairs favorable to the malady under consideration. Every night a bath should be taken; but as this is not always possible in every house, the entire body should be washed off each night before lying down. Laboring men who work in the sun have no excuse for neglecting this, for water costs nothing, and three minutes of time is all that is required.
* The Aromatic Spirit of Ammonia, and Brandy, quite indepen- dent of their intrinsic worth, are the two stimulants usually referred to, because most likely of all others to be found in an emergency. For the same reason, all through this treatise, but few simple appli- ances are directed, and these easily secured. It is an application of the principle of, one good thing always to be had; rather than a dozen better, which can not. AeCtfiENTg—tiMfiftGE^CtEg—t-OISONS. 21 Drinking large quantities of cold water, merely because it is cold, should be avoided immediately before, during, and after meals. The debility resulting from the heat weakens the digestive powers, and water unnecessarily used to excess at the times named tends still further to retard.the digestion of the food, by further weaken- ing the solvent action of the secretions of the stomach. In other words, if there is a time above all others, the year around, when every precaution for the preservation of health is re- quired, it is during the hot months of summer. Loosely fitting light garments should be worn, if possible. Par- ticular attention should be given the head. It should be protected from the heat of the sun, and at the same time the covering worn should favor the circulation of a free current of air over the scalp. A straw hat of loose texture, with a lining to the crown which could be kept constantly wet, ought to be worn; and if it has brim enough to protect the neck, and even the shoulders, the wearer is just that much more fortunate than other people. While attention should be paid to these things in hot weather, it is particularly necessary, should any of the named symptoms be observed on any special day, that the greatest care should be taken, if work in the sun is absolutely necessary, that the symptoms do not extend into an attack of sunstroke. Discontinuance of work, if possible, until the symptoms disappear, in such a case, would seem to be the best course to be pursued. It is said that persons who have once suffered from sunstroke, for a long time after are unable to bear exposure'to the heat, with- out a recurrence of the symptoms of the malady. ACCIDENTS FROM LIGHTNING. A person struck by lightning is usually rendered more or less unconscious by it, which lasts for a longer or shorter time. Cases are on record where a person struck exhibited no sign of life for an hour, and then recovered. Temporary paralysis of a portion of 22 AfiClSfi^Ta—filitfitl6ENCTE§—POISONS. the body may remain for a while, as well as disturbance of some special function, as the sight, smell, taste, or hearing. The turns caused by lightning should receive the same attention as a burn from any other cause. Sometimes an injury observed is not directly due to the electricity, but from a fragment detached by that agent from a neighboring substance. When death takes place, it is from shock, as it is called, to the brain and nervous system. "When tlie person exhibits little or no signs of life, the clothing should be rapidly and immediately re- moved, the body exposed to a dashing of cold water; then dried, placed in bed, and warmth applied, particularly to the "pit of the stomach," by means of bottles filled with hot water, or tlie tin ves- sel kept in some households for such application. It is somewhat concave on one surface, filled with hot water, and, if it can be had, is well adapted to the purpose. Artificial Respiration should be kept up until the parts of the brain and nervous system in charge of this duty sliall have recovered enough to attend to it. As said before, recoveries after an hour of supposed death arc on record. Some stimulant, as the Aromatic Spirit of Ammonia, may be used. Twenty drops in a table-spoonful of water, every few min- utes, may be given; or a tea-spoonful of Brandy instead. SHOCK. Mild forms of Shock, or Collapse, as it is sometimes called, are often, by the non-professional, confounded with Fainting (Syncope). As far as the symptoms extend, the symptoms of an ordinary attack of Fainting are analogous to those of Shock. The symp- toms between the two vary rather in degree and duration than in kind. Life may be destroyed by certain agencies, as a blow upon the "pit of the stomach," or a sudden and powerful emotion of the mind, and no visible trace be left in any part of the body. It is called "Death from Shock." This is the extreme result of Shock. ACCIDENTS—EMERGENCIES—POISONS. 23 Usually the patient lies in a state of utter prostration. Thcle is pallor of the whole surface; the lips are bloodless and pale. The eyes have lost their lustre, and the eyeball is usually partially cov- ered by the drooping upper lid. The nostrils are usually dilated. The skin is covered with a cold, clammy moisture, often gath- ered in beads of sweat upon the forehead. The temperature is cold, and perhaps the person shivers. The weakness of the mus- cles is most marked; as the phrase is, "the patient is prostrated." The mind is bewildered, often insensibility occurs, unless aroused; and, in many cases, nausea and vomiting. In extreme cases, tlie nausea and vomiting are not so apt to occur. Sudden and severe injuries, particularly if extensive in character, and involving a large amount of texture, cause Shock. Burns— especially of children—extending over a large extent of surface, even if not extending to a great depth, are often followed by Shock, and this complication requires often the earliest attention. Certain poisons, as Tobacco, and Tartar Emetic, act in this man- ner, depressing the system. So does a current of electricity, as is seen in the effects of lightning. Loss of Blood produces or aggravates Shock. Hence a slight injury, with much loss of blood, may be attended with more Shock, than a comparatively more severe injury without tlie loss of blood. Debility favors the influence of Shock. A weak system is more easily impressed by it, and, as should be expected, reaction from its effects is longer in taking place. As the vital powers of life decline, from engrafted or natural causes, there is less power available as a reserve to meet contingen- cies. In youth there is an available fund of this kind; in the adult tlie resources of the system may be equal to the task of ordi- nary maintenance, but in the aged, as said before, there is much less ability to deal with sudden losses of strength. The aged, there- fore, are slow to rally from the effects of Shock. They have more power of resistance than the young. The shock does not readily make an impression, as it does in the young, but when it 24 ACCIDENTS—EMERGENCIES—POIS6N§. does, the impression endures. In the young the impression is more easily made, but sooner subsides. Treatment of Shock Consists in first placing the patient as flat on his hack as possible, with the head raised not over an inch. This is an important point in cases of ordinary Fainting, and whenever the vital powers are depressed. Stimulants are required. The aromatic character of Brandy enables it to be retained by the stomach when Whisky and other forms of Alcohol are rejected. A tea-spoonful in a table- spoonful of water every minute, until six or eight have been taken, is the best way to give it. If the temperature of the body is raised by it, and there seems a revival of the action of the heart, enough Brandy has been given. Twenty drops of the Aromatic Spirit of Ammonia in a tea-spoonful of water may be given every couple of minutes, until four or five doses have been taken. The applications of heat to the extremities and "pit of the stomach" are very useful. Flannels wrung out in hot water, or bottles of hot water properly wrapped up, should not be neglected. In some households, a tin can, somewhat concave on one surface, to fit the curvature at that point, and with a stopple in the upper surface for the introduction of the hot liquid, can be usefully em- ployed for heat to the epigastrium ("pit of the stomach"). Mus- tard-plasters to the same place are often used, but they are so in- ferior to heat for the purpose, if that can be applied, and so apt to blister, thereby making it impossible to use any thing else on the surface, that some reluctance is felt in advising them. Nausea and vomiting often are seen in Shock, and can best be allayed by getting the patient to swallow wliole, small chips of ice. Ice, by the way, can be easily chipped by standing the piece with the grain upright, and splitting off a tliin edge with the point of a pin. Ammonia (smelling salts), applied to tlie nostrils, is often use-