ACCIDENTS-EMERGENCIES—POISONS. 2S ful; and cologne, on a handkerchief, is often pungent enough to be of service in the same way. Shock from Bathing in or Drinking' Cold Water. In the hot weather, cases often occur where death or great pros- tration ensues from drinking ice-water, or bathing in cold water, while the body is exhausted from hcnt or exercise. The same thing happens to animals under similar circumstances. Cold water in liot weather, if the person is Pleated, should always be drunk in small quantities at a time. If not, although neither death nor pros- tration may follow, a troublesome derangement of the digestive tract ensues, often laying the foundation for other troubles. When the body is heated, or exhausted, a bath in cold water ought never to be taken. A sponge bath will answer, until tlie vigor of the body has had time to be restored. These troubles can be referred to Shock, and should be promptly treated as such, according to the given directions. FAINTING. Persons often faint without any proportionate cause. Debility of the nervous system favors it. "While the author would not like to say that the tendency to swoon can be intentionally acquired, he is compelled to think it can be unintentionally perpetuated under many circumstances. The treatment usually followed is, perhaps, the best; but peo- ple are apt to raise the Tiead of the patient. Even in carrying her to the bed or sofa, it sliould be kept lower than the rest of the body. Indeed, tliere is no better restorative in such cases than such a relative position of the extremities. Should the person be sitting in a chair at the moment, do not remove her, but stand be- hind the chair, reach the hands over in front, so as to grasp the sides of the back of the chair, take a step backward to give room, and then slowly depress the back, supporting the head until the floor is reached. An assistant, by holding to the dress over S6 ACCIDENTS—BMEHOENCIES—POISONS. the knees -will prevent lateral slipping off from the seat of the chair. It is so rapidly and easily done, besides so effective in its operation that little else remains to be done. Usually the back of the head of the patient scarcely reaches the floor before conscious- ness returns. BURNS AND SCALDS. These common accidents, by receiving early and suitable atten- tion, are often deprived of much of their inconvenience. Of course, the first thing is to put the fire out, and then, if the in- jured parts require it, the clothing should be cut away, so as to get at the entire extent of the injury -with as little trouble to the patient as possible. Should any fragment of garment appear ad- herent to the burned surface, the sticking part should be left, as the violence required to remove it must necessarily increase the damage to the injured part.
When the clotliing catches fire, throw the person down on the ground, as the flames will tend less to rise toward tlie mouth and nostrils. Then without a moment's delay, roll the person in the car- pet or hearth-rug, so as to stifle the flames, leaving only the Iicad out for breathing. If no carpet or rug can be had, then take off your coat and use it instead. Keep the flame as much 0,1 possible from the face, so as to prevent the entrance of the hot air into the lungs. This can be done by beginning at the neck and shoulders with the wrap- ping. ACCtfiroWs—EMEBGfiNciEs—POISONS. 27 If the burn or scald involves considerable surface, symptoms of shock are observed, from the extreme of mere weakness to that of utter prostration. This at once requires prompt attention, and a few drops of Aromatic Spirit of Ammonia in water, or a little Brandy, should be given every few moments until a return of the strength is seen. A burn, superficial as far as depth is concerned, but covering a large stvrfwx, especially in the case of small children and aged people, is usually considered more dangerous, as far as life is concerned, than a burn smaller in extent, but deeper and more complete. Never mind how slight tlie injury appears, if there is reason to suppose the heated air or steam has been inhaled, no time should be lost in taking the opinion of a physician as to the result of the injury to the throat and lungs, Treatment. If the burn or scald is slight in character, one of the best appli- cations is tlic Water Dressing, p. 32, as tliere said, keeping the linens used, constantly wet with cold water. In a short time after the pain shall have moderated, one of the best things for use, and readily procured, is a dressing of pure hog's lard. The common lard of the stores will scarcely answer, from the impurities it con- tains. At the Infirmary in Lombard street, they usually direct tliat half a pound, or less, of the best lard should be bought, and put into a vessel of hot water, boiled a few moments, being stirred with a stick until it is thought all tlie salt used for preserving the lard, and tlic alum put in to bleach it, have been washed out. The vessel is tlicn set aside until tlie floating lard hardens. It is tnen collected, placed in a bowl, which in turn is placed in a ves- sel of hot water on the stove, and kept there until the water me- chanically held by the lard .has been driven off. The bowl of lard is heated by surrounding water, to prevent seorcJdng. After thus prepared, the lard may be considered perfectly pure, and can be put away in suitable vessels until required for application, 28 AcdDEKTs—EitEfi6E»rotEs—PdisCiVS. It is much better than the commonly used Linseed Oil and Lime "Water, as the Linseed Oil is rarely pure, but contains irri- tating substances left in the manufacture, or added for the purposes of adulteration. "Wheaten Flour is often dusted over the burn; but this, with the discharges, Tiardens, and is of as little comfort as an application of small crusts of bread would be to the injured part. Cotton wool (carded cotton, cotton batting) is often used, but the fibers become imbedded in the discharges, and then can not be detached without unnecessary pain and disturbance of the wound. If the burn or scald, particularly the latter, is superficial in char- acter, a simple and useful dressing is the application, by a brush, or a soft wisp of old muslin, of tlie White of Egg to the injury. As soon as the first layer dries, another should be used. In super- ficial burns and scalds, this treatment is especially grateful. A lather of soap from tlie sh.-iving.cup, applied by (lie brush in the same way, is often followed by immediate relief. Tliese sub- stances appear to protect from the action of tlie air the irritated nerves beneath. As before said, do not apply "cotton" to the injury, as sooner or later it increases the pain, and without having done any special good. If a physician has been sent for, it is better not to make any domestic applications to the burned parts. Such things frequently prevent him from using those better adapted to the wants of the person, and keep him, too, from forming a correct estimate of the real extent of the injuries. "Where the effects of the burn or scald extend deeper, involving the subcutaneous tissue, or even the parts beneath that, as the mus- cle, other considerations must not be overlooked. Tliero probably will be more shock. The portion whose vitality has been destroyed by the bum can not do otherwise than become detached from the uninjured parts beneath thrown off in the shape of shreds or larger masses, during tlie process of sloughing. After water- dressing has given a degree of relief to the part, and this is some. ACCIDENTS—EMERGENCIES—POISONS. 29 times sooner secured by adding Laudanum (Tincture of Opium) to the water, a system of Poulticing* must be commenced. After being used for a short time, a mark of -well-defined separation, is seen at the junction of the burned and the unburned parts. The edge of this dead portion often falls away, like a piece of wet buckskin, showing, except at the edges, a union of the dead and the living parts. This process of separation continues for some time attended with such profuse discharges that the poultices must be changed several times a day to preserve neatness; but after a while the entire mass lies loose, attached only at the cen- tre to a raw suppurating surface below. A short time after the whole mass becomes detached and is removed. Then at the edges and surface of the uninjured parts a process of filling up the wound by "granulation" must commence. The newly-formed substance begins first to be deposited at the edges of the wound, generally reducing the area. This process, in such a wound, the result of a burn, is much less rapid than might be supposed by the unprofessional, and is attended with much suppuration (making of pus). Whenever the destructive process of suppuration goes on in the body, from whatever cause, there is exhaustion of the strength. This must be combated by a judiciously selected diet; and some- times by appropriately selected tonics. Often, the surface under- going repair is benefited by local applications; but these can only be appropriately selected by a physician, so nothing need be said about them here. As remarked above, in burns beyond a certain degree of de- struction, the process is one of repair rather than restoration. In- stead of the destroyed portion being replaced, the reparative mate- rial is of such a character that it undergoes contraction; and great deformity may result from its dragging effects upon adja- cent healthy parts. These effects may often be mitigated in ex- * " Recipes for Sick People." Sometimes bound with this, 32 ACCIDENTS——EMERGENCIES——POISONS. the injury. Thus a crushed finger is attended, as a rule, with much less shock than a crushed hand or foot. Contusion of cer- tain parts, as the larger joints, breasts, and other portions of the body, are followed by most severe symptoms of shock. The pain is not always as severe as might at first be thought, for it is said the nerves are so much injured as to be deprived of their ability to receive and transmit the necessary impression. The swelling de- pends, at first, largely upon the Slood poured out by the injured vessels, and as just said, this depends upon tlie number and sine of the divided vessels, as well as upon tlic character of the part containing them. Treatment. In the milder Contusions, there is but little shock. Should there be more, place the patient on the back, head not elevated, and give stimulants as directed. See Shock, p. 25. Tlie next thing is to limit the consequences likely to ensue from the rup- tured blood-vessels. This is best done by lessening the supply of blood to the part by elevating it, if possible, above the heart, and using cold applications in the shape of powdered ice, tied. up in towels, to the part; and along the course of the larger vessels going to the injury. A large piece of ice secured in a towel, so the fragments can not escape, can be reduced to fine fragments by a blow or two against the wall. After it has remained on for a time, the water may be substituted in the shape of a drip;* or several thicknesses of wet towel may be applied, only they must be dipped in cold water, squeezed out, and changed every sixty seconds. If not changed, the wet towels really act as poultices to the part, inviting what we should try to prevent. When the Surgeon appears, special meas- * A pitcher, or some other vessel of water, placed higher than the limb, with a moistened string or strip of linen. The end of the string is placed in the water, the other hangs down on the outside, so the water will drip along the string from the veisel to the injured part. ACCIDENTS—EMERGENCIES—POISONS. 33 ures -will be directed by him. Recollect it takes a great deal of heat to convert ice into water, and water into vapor, and if the patient has not got this heat, symptoms of chilliness -will be ob- served. When this happens the application must be stopped and the moisture must be taken up by a towel; particular attention always being paid to keep the bed-clothing, and every thing else, perfectly dry and neat. Discoloration is due to the color of this escaped blood, seen through the cuticle, and varies from blackness usually indicating intense injury, so that the blood itself is poured out, through dark blue, purple, crimson, down to delicate pink, indicating only a blood-stained fluid. After preventing the escape of blood from the vessels, as far as practicable, there remains to get rid of what has already been poured out. In some forms, the assistance of professional advice will have been secured. In simpler cases, the blood, at this later stage, should be encouraged to flow through the now repaired vessels and the neighboring vessels as much as possible. By this means the deceased particles are, as it were, picked up, as physi- cians say, absorbed, and replaced by healthier ones. The color of the part gradually fades in proper time, and the injury is said to be restored. Gentle frictions of the part and neighborhood, tlie application of dry heat, and stimulating lotions, as Alcohol, Cam- phorated Soap Liniment, with other simple things of the same char- acter, are often used with the intention of assisting this process of nature. A common accident is a "mashed finger" from the member getting caught in a closing window, or want of precision in using a hammer. The firm bone beneath and the blow above usually contuse (bruise) the tissues (veins, vessels, muscle, etc.,) between, and often the pain and other symptoms last some days. Wrap up in a bandage of old muslin, keep constantly wet with cold water. If there is much pain add Laudanum (p. 130), or the 34 ACCIDENTS——EMERGENCIES——POISONS. Tincture of Arnica, (p. 129), recollecting they are not curative agents, but only lessen the pain by benumbing the injured nerves. It is unnecessary to say that a " mashed toe " is to be treated in the same way. The discoloration and swelling (p. 34) may remain some days after the pain subsides. Stimulating Liniments can now be used to encourage an extra flow of pure blood to the part, and the washing away of the injured blood. FRACTURES AND DISLOCATIONS. It is often evident to a bystander that a Fracture or Dislocation exists, without knowing what can be done in the interval which must elapse before the arrival of competent professional assistance. Of course no one but a very ignorant and bold man would attempt to do more than make the sufferer comfortable in the meanwhile.
In instances of suspected Fracture or Dislocation of the lower extremity, the injured parts should be placed in comfortable posi- tion, and as well supported as possible, to prevent the tmtchings of the leg from the spasmodic action of the muscles of the injured extremity. If necessary to remove the patient to his home or the hospital, from the spot where the accident happened, the arrange- ment of the limb should be made after he has been placed on the stretcher or substitute. If found necessary to carry the injured person some distance, tnd a litter for the purpose can not be had, the arrangement of the ACClaSNTS—EMERGENCIES—POISONS. 35 fractured limb against the other, and kept there by handkerchiefs, as shown in the cut, is often of great comfort to the sufferer. If tlie general character of the injury is evident, in sending for the surgeon it is best to tell the messenger, so that, as far as pos- sible, tlie necessary appliances can be provided before leaving the office. In the mean while, under no circumstances, sliould the bystanders be permitted to handle the affected part beyond what is absolutely necessary. As a general rule, a much longer time than is com- monly supposed, by most people, may pass between the occurrence of the accident and the arrival of the surgeon without serious in- jury to the patient or ultimate disadvantage to the fracture. Many persons, thinking that the broken bone must immediately be "set," ore apt to accept the services of the first person arriving asserting himself qualified to do it. Such an individual necessa- rily makes a more painful examination than is necessary, applies the splint—perhaps not at all the most useful—which the surgeon, arriving later, is obliged, out of consideration for the condition of the sufferer, to acquiesce in. If the injury is to the upper extremity, the part should be placed in a supporting sling, and kept in a comfortable position. Sometimes,, owing to the severity of the injury, or the condition of the general health of tlie person at the time, symptoms of Shock, from the mildest expression to insensibility, are observed. In such a case, the measures of treatment suggested under that head can be followed until other advice is obtained (p. 24). Dislocations. These result from force applied in such a way as to dislodge the surface of one bone from another; what is called the head of the bone slipping off into a neighboring depression. Of course the ligaments binding the parts together are torn and stretched, be- yond tlie point of slight elasticity found in such tissues, and the adjacent parts are badly contused (bruised), p. 3. 36 ACCIDENTS——EMEBGENOIES——POISONS. No direction can be given for detecting a dislocation. It is some- times evident to the sight, but tlie possibility of a fracture must be remembered, and the patient made comfortable, without 'hand- ling the injured parts until aid can be summoned. A dislocated joint is always afterward a weak one, and a small part of the force originally used will produce a return of the trouble. Sprains. In a sprain, the joint is twisted, so that the ligaments binding the parts together are severely stretched or even torn, with consequent violence to the delicate lining of the joint. A sprain is understood to be short of displacement of the surfaces of the bones, which would be a dislocation. They most frequently occur at the wrist and anklc-jointa. The injury is rapidly followed by inflammation of the joint and adjacent parts. Not only is the joint directly weakened by the injury, but if there is a tendency to rheumatic disorders, or the constitutional leaning known as ftmmous, no little future trouble often follows. There is, of course, great pain, and if it is the ankle or wrist- joint injured, often nausea. The tendency to inflammation should be discouraged by resting the whole body, and keeping the sprained joint elevated. Cold water in the shape of a "drip" (p. 32), should be used plentifully until the opinion of a physician can be taken. Complete rest must be kept up until the inflam- mation shall have passed and the probably torn ligaments been restored. Later, stimulating liniments can be used. Often a frac- ture of the shaft of the bone results in a speedier restoration than the sprain of an ankle-joint. WOUNDS. For systematic study, wounds may be classified according to their direction, or depth, or locality; but for our purpose they may be arranged after the mode of their infliction. (1.) Incised wounds, as cuts or incisions, including the wounds where portions