Chapter I: Preface (1)

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The object of this work on “Accidents and Emergencies” is to inform the general reader of “What to do, and how to do it,” not only in the first instance, but in those cases where professional assistance cannot be readily obtained, and in language that any person of ordinary intelligence can understand and apply.

Accidents both on land and water are of common occurrence and may happen to any of us. To know what should be done at once in our efforts to assist others in accidents that might have occurred to ourselves is a part of our duty to our neighbors; though the necessary presence of mind and capacity to use that knowledge is not in the power of any work to supply.

Should this work prove the means of having alleviated pain and assisted the subsequent professional treatment in restoring the sufferer to health, the author’s hopes will have been realized and his labors repaid.

J. B. L.

265 West 43d Street, November 1st, 1888.

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CONTENTS.

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PAGE.
Accidents and Emergencies 7
Accidents. How to avoid them 123
Accidents on the Water 11
Apoplexy 12
Asiatic Cholera 15
Broken Bones—Fractures 19
Bruises 30
Bleeding from the Nose 31
Bleeding from Cut or Wound 33
Burns and Scalds 34
Catalepsy—Trance 37
Choking 39
Cholera Morbus 40
Clothes catching Fire 42
Colic 43
Concluding Remarks 128
Cramps 51
Diarrhœa—Looseness of the Bowels 52
Dislocations 56
Drowning 61
Effects of Cold—Frost Bites 64
Epilepsy—Epileptic Fits 67
Fainting Fits 72
Fish-Hooks, Crochet Needles, Thorns,
Splinters, etc., in the Flesh 73
Fits—Convulsions 75
Foreign Bodies in the Gullet 78
Foreign Bodies in the Windpipe 79
Foreign Bodies in the Ear 80
Foreign Substances in the Nose 82
Hydrophobia—Rabies 84
Lockjaw 86
Paralysis—Palsy 87
Poison—Ivy 91
Poisons 91
Poisons and their Antidotes 93
Presence of Mind. Take Things Quietly 125
Sea Sickness 99
Snake Bites 102
Sprains or Strains 104
Stings of Insects 107
Suffocation 108
Sunstroke 110
Things in the Eye 113
Tooth-ache, Pains in the Face and Jaw,
Ear-ache 114
Wounds 116

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ACCIDENTS AND EMERGENCIES.

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The present work has been undertaken in the belief not only that it will supply a want felt by those who have had no surgical education and training, and are by circumstances placed where professional skill and assistance cannot readily be had, but also in the desire of imparting to such a general knowledge of the nature, course of treatment, and ordinary results of such accidents and emergencies that are of common occurrence and a description of which has ordinarily to be sought in technical works intended for professional readers and understood with difficulty by others.

Accidents, (_a_, from cadere, to fall,) are events that happen suddenly, and are beyond man’s foresight and control.

Emergencies, (_e_, from mergere, to plunge), taken in this connection are conditions, or connection of circumstances calling for prompt action and a ready resource. Colic, Cholera, Diarrhœa, etc., cannot, strictly speaking, be regarded in the light of accidents, but the suddenness of such attacks lends them all the gravity that attaches to “Accidents.” In this sense, the terms “Accidents and Emergencies” have been coupled together as the title of this work, and in which they have been treated in the following pages. Life is beset with possible perils. Infractions of the moral, no less surely than those of the natural law, bring punishment which ignorance and selfishness invite. But there are dangers to which we are exposed through causes beyond our control. In such cases, presence of mind, and the power of taking things quietly, is of the chiefest importance. “Old women of both sexes,” who give way to their feelings by hysterical screams, or even hinder those who know what to do, not only complicate matters, but are a nuisance that should at once be removed. In such cases it is doubly true that “he who ruleth his spirit is greater than he who ruleth a city.”

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Not every one can preserve the requisite coolness and decision of character, when suddenly called upon to do so; but there are some who can master their own feelings and overcome the natural dread of blood and pain sufficiently to forget self in those larger and nobler feelings evoked by that “one touch of nature which makes the whole world akin.”

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With these few brief introductory remarks I will proceed to consider the immediate effects and treatment of such Accidents and Emergencies as are of ordinary occurrence, namely:

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Accidents on the Water.

Many such occur yearly, and much loss of life and personal injury can be prevented by exercising a little common sense and self-possession. If swamped or overturned in a boat, and unable to swim, your chief endeavor must be to keep your head above water. This is easily done if you will simply throw yourself on your back, lying perfectly still, just moving the _hands_ to and fro on the water, in the same level with the body. Or else fold the arms over each other, keeping them some little distance from the body, the latter being in a perpendicular position, instead of a horizontal one, as in the former case. When on board a vessel that has been run down, do not crowd round the boats and thus hamper the efforts of the sailors, nor to that side to which the vessel lists. The story of the “Birkenhead” shows what discipline and coolness will do in saving human life.

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Apoplexy.

Apoplexy may be defined as the sudden deprivation of all the vital functions, save those of the heart and lungs; though feeling and will are at once suspended, and in an instant, and often without any premonitory warning, a person in apparently robust health falls down in a state of insensibility, and as if in a deep sleep, stricken down by the sudden blow. One form of the attack is, (A) where the face becomes flushed, the breathing heavy, and the pulse full and not frequent with occasional convulsions. But the attack may be preceded, (B) by a sudden pain in the head accompanied by faintness and vomiting; the skin becomes cold, and the pulse feeble, and at times convulsions follow. The patient may fall to the ground, but will revive for a while and recover from all these symptoms, though the headache will continue, and then by degrees he becomes heavy and forgetful, and his ideas wandering and disconnected, till at last he sinks into a state of stupor from which there is no recovery. This form of attack, though less alarming, at the beginning, to those present, is more dangerous than the one previously mentioned. The tendency to these attacks increases with advancing years, and more generally between the ages of 45 to 60, and to persons of square stout build, with short necks and large heads, though their opposites physically are by no means exempt. Men are more liable to apoplectic attacks than women; youths and children rarely suffer from them. Apoplexy may be _cerebral_—that is, arising from congestion or rupture of the brain; or _pulmonary_, due to hemorrhage of the parenchyma of the lungs. The _first_ is the commoner form. The attack may be sudden and violent, or comparatively slight at first and progressive in intensity; or it may commence with apoplexy terminating in paralysis, or commence with the latter and terminating with the former.

CAUSES. Apoplectic attacks are due to constitutional predisposition or exciting causes, among which may be mentioned sex, age, bodily conformation—all of which have already been touched upon above. Excessive mental anxiety and exertion, such as business troubles, or extreme emotions or passions; too free indulgence in either eating or drinking, especially by persons of advanced years; severe bodily or mental strain, in fact, whatever produces a tendency to quicken the circulation of blood to the head, or retards its return from it.

TREATMENT. When the symptoms are such as described in the first form (A), immediately place the patient in a recumbent position, with the head and shoulders raised, remove everything about the neck and loosen the clothes. Admit the air freely, and apply ice—if obtainable—or cold wet clothes to the head, changing them frequently. In the second set of symptoms mentioned, (B), raise the head and shoulders, loosening the clothes, and removing whatever presses on the neck, applying ice, etc., as set forth above; but the patient’s skin being cold and the pulse small and fluttering, apply strong spirits of ammonia to the nostrils and hot flannels to the legs, and hot water-bottles to the feet, or put the feet into warm water with a little mustard. Then, if the sufferer is able to swallow, administer slowly from 15 to 20 drops of aromatic spirits of ammonia in a half glass of water, or one-half dram of aromatic spirits of ammonia in one and one-half ounces of camphor mixture. Purgatives should be given as soon as possible, 10 grains of calomel placed on the tongue, followed by a black draught; or 2 or 3 drops of croton oil rubbed on the back of the tongue, and an injection given composed of two table-spoonfuls of common salt with a little butter; or a pint of warm water; or an injection composed of soap suds and four ounces of sweet oil. If the attack be after a heavy meal, an emetic should be administered of a scruple of sulphate of zinc with a grain or two of tartar emetic. To guard against future attacks, mild tonics should be taken, the body daily washed and rubbed and the bowels kept well regulated. It is hardly necessary to add that on any occasion of an attack a physician should at once be called in.

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Asiatic Cholera.

This terrible disease is of a very violent and sudden character. It attacks a person without any warning, and generally within a few hours leaves him—a corpse.

CAUSES. The actual cause is not well determined, but the effects are most disastrous in crowded towns and cities where dirt and disregard of sanitation prevail. Impure water, improper food, indulgence in sensual habits, and intoxicating beverages, or whatever tends to weaken and undermine the constitution, are all so many invitations to a visitation of this dire disease. Fear, especially when the epidemic is present in the district, is also a not infrequent cause.

SYMPTOMS. The attack of the commencement is marked by derangement of the digestive organs, want of appetite, pains in the loins and knees, thirst, and looseness of the bowels; then follow sickness and purging—the discharges having the appearance of rice water, very unlike those presented in diarrhœa, or bilious purging—accompanied by severe and painful cramps in the calves of the legs, and afterwards in the bowels, stomach, and other parts of the body, which becomes bent, with the limbs twisted. The thirst is intensified, the breathing hurried and difficult, with a hardly perceptible pulse. The eyes are sunken and surrounded by a dark rim, and the skin is cold and clammy; there is a feeling of intense heat in the stomach accompanied by violent thirst. The patient is entirely prostrated, and sinks into a state of apathy, from which, unless a change very speedily takes place, he never recovers.

TREATMENT. Although the writer has met with a case where the patient recovered when all hope had been abandoned; still when once the disease has taken hold of a person, it is very seldom indeed that he is ever again restored to health. There is no known cure, or any proper course of treatment to be followed, agreed upon by medical men whose views of how this disease should be treated, have of late years undergone somewhat of a change. The time when a cure is most likely to be effected is at the initial stage. Put the patient to bed, and apply hot bricks and fomentations to the extremities and mustard plasters to the bowels, the looseness of which should receive prompt attention. Five to ten drops of laudanum, repeated a few times every three hours, will generally put a stop to this. Dr. Watson[1], however, expresses as his opinion, “that the one important and guiding rule of treatment is not to attempt by opiates or by other direct repressive means to arrest a diarrhœa while there is reason to believe that the bowels contain a considerable amount of morbid and offensive materials. The purging is the natural way of getting rid of the irritant cause. We may favor the recovery by directing the patient to drink copiously any simple diluent liquid—water (cold or tepid), toast-water, barley-water, or weak tea; and we may often accelerate the recovery by sweeping out the alimentary canal by some safe purgative and then, if necessary, soothing it by an opiate.” The diet should of course be very carefully regulated, and more sparingly partaken of than in health, but not particularly changed except to abjure all food known to be indigestible and injurious. When the patient reaches the stage of purging, vomiting and cramps, the treatment must be energetic. The failing powers must be sustained by chloroform, opium and ammonia, or camphor, opium and cayenne. Brandy may also be freely administered and the warmth of the body promoted by all possible means. These remedies should be energetically pursued, especially the stimulants, and the efforts to promote warmth in the surface, until the final stage of prostration and apathy is reached.

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Broken Bones.—Fractures.

Falls, and other trifling accidents occasioning the breaking of some bone or other, are among the commonest incidents of life, (particularly in the cold weather, when the bones are more brittle than at other times), often occurring when surgical aid cannot be immediately obtained. The fact that a bone is broken is easily detected by the inability to raise the limb, or from its being bent, shortened, or twisted, as also from the pain. Much additional suffering may be spared the patient, and increased mischief prevented by the exercise of a little care and judgment.

The limbs should be tied together, or placed as near as possible in a natural position, and the patient laid on a door or hurdle, covered with straw, blankets, etc., upon which he should be laid as gently as possible and carried to the nearest house. If no hurdle, etc., be available, a convenient frame can be readily extemporized by tying firmly two short poles across two long ones, and laying upon these a few planks, covered with straw or clothing, etc.; or, a blanket securely attached to the four corners, like a cot-bed, will adequately fulfill the end in view. In dealing with the treatment, we will commence with the head, working down to the extremities.

HEAD. All injuries sufficiently severe to break any bones in the head or face, or to produce insensibility, are especially dangerous, and need immediate skilled attendance. The head should be raised and cold water applied, particularly if there be any bleeding, and the sufferer kept as quiet and free from excitement as the circumstances will permit.

COLLAR BONE. This bone runs from the top of the breast bone to the shoulder. This fracture is perhaps one of the most ordinary accidents that can happen, as it is also one of the most readily detected. It generally occurs about the middle of the bone, and is commonly caused by falling upon the arm or shoulder. The fracture will be noticed by a lump, the broken bones rising one above the other, with considerable pain and tenderness in the injured part, and inability to raise the arm. The principal object is naturally to keep the shoulder back so as to facilitate the union of the bones. The most simple and efficacious way for non-professional persons to effect this, is the following. Make a round pad of some soft material, about five inches long and thick, and wrap it in a small shawl. Push the shoulder backwards, pressing the fracture with the other hand, till you get the bones back into their proper place. Now place the pad well under the armpit on the injured side, bringing the ends of the shawl back and front over the opposite shoulder, then crossed and tied under the sound arm. The sore arm should be well supported in an ample sling, extending from the elbow to the wrist. A surgeon should then be seen to set the fracture right. If there be a tendency to swelling, the arm will require to be bandaged from the fingers upwards.

BROKEN RIBS are generally due to a fall or blow affecting one or more of the bones. A sharp pain is experienced, which is intensified when taking a deep breath or coughing, and by placing the hand upon the injured part a grating sensation will at the same time be felt. A possible injury to the lungs from the sharp points of the fractured rib, and the consequent inflammation, is the chief danger to be apprehended from this accident. If there should be any spitting of blood, the patient must be kept perfectly still, and no stimulants given him. A piece of some stout material, from 8 to 10 inches wide, should be bound tightly round the chest several times to prevent the rise and fall of the ribs in breathing, commencing as near as possible to the armpits, down to the pit of the stomach.

If there be a bruise, apply hot fomentations, hot plaster, or hot bran-bags. Should there be any inflammation, the patient must be kept to his bed, resting in that position which affords him the greatest comfort, and restricted to a low diet. The pulse must be quieted by administering a dose of from 3 to 5 drops of tincture of American hellebore (veratrum viride) every one or two hours in a little sweetened water, and gradually increasing till the pulse comes down to about seventy. If the accident occur away from the house, bind some substantial substance tightly _over the clothes_, until the sufferer can be conveyed home. In all cases of a wound to the chest, the person must lie on the _wounded side_.

ARM. _Above the elbow._ A fracture of the humeral, or upper arm bone, occurs most generally about the middle, but less commonly within an inch or so of the extremities. It can be readily detected by taking hold of the arm, just above and below the suspected fracture, and trying to bring the upper and lower portions together, when the broken ends can easily be felt, and a _grating_ heard as they rub against each other. The injured limb is bent and helpless, and if the bones overlap each other _shortened_. The arm should be pulled gently and gradually to its natural length, the operator in the meanwhile setting the bone, and a bandage applied, but not too tightly, from the shoulder to the elbow. Over this bandage, four splints, well padded with lint or wadding and of the same length as the bandage, should be placed, one in front, one behind, and one on either side of the broken bone. The splints should be furnished with tapes to tie or buckle. The arm must be confined to the side, and the hand and fore-arm carried in a sling. The dressing should be removed in a week or ten days, to see that all is right and proper progress made.

ELBOW. In this instance, though the patient is able to bend, he cannot straighten his arm, which when moved backwards and forwards makes a grating sound and gives intense pain. Falls or blows are the usual causes producing this fracture. The point of the elbow seems gone, being drawn into the back of the upper arm. Apply leeches and evaporating lotions to reduce any inflammation that may be present. When this is done, straighten the arm and bandage carefully from the fingers to the joint, and set the broken bone, continuing the bandage, passing it over and above the injured part. A well padded splint, extending from the hand to nearly the shoulder, should now be applied on the inner side and a similar one on the outside of the arm. The joint must be rested from four to five weeks, removing the splints some three or four times during that interval to ascertain that the skin is not being chafed, nor the bone disturbed.

ARM _below the elbow_. In the upper arm we have but one bone, but here there are two: one running from the elbow to the wrist at the end of the little finger, and the other on the side next the thumb. When both bones are broken the fracture can be readily detected, but not so when only one is broken, as the sound bone assists to keep the other in place, and the injury is not so easy to discover. In a fracture of the outer and thicker bone (ulna), the arm seemingly retains its normal shape, though broken at the elbow or some other part of its length. In this case the elbow should be bent and the hand turned upwards, as if to lay it flat on the chest. Then apply two splints, placing one on the palm of the hand reaching to the bend of the arm, and the other, and outer one, from a little beyond the elbow to about the knuckles. The arm should be well raised towards the chest, so as to keep the outer from the inner bone (radius). When the fracture occurs in this inner bone, the same treatment must be observed, with this one exception: that to ensure the bones being kept apart, the hand must be _lowered_ instead of raised. When both bones are broken, the operation is naturally a more difficult one and requires skilled attention. In bandaging fractures, due allowance must be made for swelling, which is present during the first two or three days.

HAND, WRIST, or FINGER.

HAND. Fracture of the _Hand_. An accident to these bones, which lie between the wrist and the fingers, should be treated in the following way. Place in the palm a ball of small but firm material, or a ball of newspaper rolled tightly, closing the thumb and fingers tightly over it, and bandaging them in that position to preserve the natural arch, which the application of flat splinters will not do. The arm should be supported in a sling from four to five weeks to permit the bones to re-unite.

FINGER. Fracture of the _Finger_. After gentle extension and counter-extension to bring the broken parts together, and having attained that end, apply narrow pasteboard splints or small pieces of gutta-percha on the upper and lower sides and bandage sufficiently tight to keep the finger in an extended position. The arm should rest in a sling from four to five weeks; and if any swelling occurs, the bandage must be loosened and cooling lotions applied.

WRIST. Fracture of the _Wrist_. In a fracture of the wrist bones apply a splint front and back and tie a bandage firmly round from above the injured part to nearly the tips of the fingers. The arm should be supported in a sling till such time as it can be prudently dispensed with.

HIP JOINT. In such accidents, to which elderly people are more particularly liable, the sufferer should be as soon as possible placed in bed, and after carefully removing his clothing, the doctor sent for.

THIGH. The fracture of the thigh bone is an accident of a very grave character, though easily discerned by the inability to raise the leg and the consequent pain in attempting to do so. The chief difficulty in this case is to obtain a proper union, for the violent spasms of the muscles, acting lengthwise, cause the fractured parts to overlap each other, occasioning much suffering. This is especially the case when the fracture is an oblique one. A long straight splint is the best to use, lightly bandaged at first and gradually tightened to accustom the limb to the pressure. If the accident occur away from home, bind the injured limb with a temporary splint, made of very thin boards or stiff straw, or with a felt hat, cut into long slips and secured by neckcloths, handkerchiefs, etc., over the fracture. On getting the sufferer home to bed, if the spasms be severe, apply a bandage around the ankle and over the instep and attach a weight of eight or nine pounds, letting the foot hang over the edge of the bed. This will give the patient much relief.

KNEE-PAN. This fracture may be either up or down, or across, but more commonly the latter, and is generally due to a fall, or as is sometimes the case, from a violent muscular exertion in throwing out the leg. The sufferer loses all natural support from the limb. The treatment should in the first instance be directed to reduce any inflammation that may be present by applying tincture of arnica, leeches, or lotions. Then _straighten_ the leg and apply a well padded splint behind to prevent any movement of the knee. The patient should be in a half-sitting posture, with the leg well raised above the level of the hip. Apply a bandage over the splint, commencing half-way up the thigh, extending as far as the fractured knee-pan; above and below the knee the bandage should be drawn tightly to prevent the broken bone from slipping under it. The broken bones should now be brought together and a bandage passed several times above and below the knee to assist the union of the bones. If the patient is obliged to move, the leg should be well supported by a firm bandage passing round the neck and under the foot, lifting the latter well off the ground.

LEG. The leg is that part of the limb between the knee and ankle, and here again, as in the fore-arm, there are two bones, the smaller one (fibula) on the outside, and the larger one, the shinbone (tibia), on the inner and front side. A fracture of the former is not easy to find, and it is not very material to do so, as the shinbone will act as a natural splint. But if this too should be broken, it is impossible to walk upon the limb, which loses its shape and becomes bent, while the broken portions may be felt or heard grating against each other. The treatment is the same as in other fractures. That is, bring the broken portions together by extension and counter-extension. Then apply two splints, one on the outer side, from the knee to about four inches below the sole of the foot, and the other upon the inside, and over these use a bandage extending from the toes to the knee. The leg may rest on any side most agreeable to the patient. The dressing can be removed in about a week’s time to ascertain if the bones have joined properly. A month, at least, must elapse before the dressing can be dispensed with, and even then the leg must be used gradually and with great care.

ANKLE and FOOT. Fractures in these cases require similar treatment as those which happen to the hand and wrist. These accidents, which are serious, are often accompanied with lacerations of the flesh and ligaments. Pasteboard splints should be used, and in case of any matter forming, it should at once be released.

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Bruises.

It is unnecessary to describe these results of accidents, with which we are all familiar in a greater or less degree from our childhood. They are easily caused and as easily cured when the injured person is in the enjoyment of ordinary good health. When the skin comes into contact with some substance harder than itself, the softer substance naturally receives an injury more or less severe (called a _bruise_), producing a rupture of a number of tiny blood vessels under the skin, giving it the appearance of “black and blue.” The _treatment_ is simple; the chief object being to prevent inflammation. Bathe the injured parts with cold water, or equal parts of Goulard water and vinegar. Or apply a lotion of one part of tincture of arnica to eight of water.

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Bleeding from the Nose.

Do not, unless it be violent, interfere with a bleeding from the nose. A bleeding from the nose is frequently an effort of Nature to relieve itself, and therefore, unless it be likely to weaken the patient, ought not to be restrained. If it be necessary to restrain the bleeding, first ascertain whether the blood escapes from both nostrils, or from the right or left. Press the nose firmly for a few minutes between the thumb and forefinger; this alone will often stop the bleeding. If it should not, inject with a syringe a quantity of ice-water or a solution of common salt, in the proportion of one table-spoonful to half a tumbler of water; or a piece of lint, twisted and moistened with the solution, may be forced up the nostril and allowed to remain until the bleeding ceases.

If these plans fail, then try what bathing the nose and the forehead with water quite cold and plunging the hand and the fore-arm into cold water for a few minutes will do. Then take them out and raise the arm above the head. The arm is raised to distribute the force of the heart’s action and to take the pressure off the carotid vessels, diminishing the strength of the current through them. This plan has frequently succeeded when others have failed. When the blood comes from laceration of the naso-palatine artery, all these measures are apt to fail and the posterior nares must then be plugged. The operation of plugging is simple, and does not require a great amount of skill. It may be performed with a gum-elastic catheter, (No. 4 or 5 will do). Through the eye of the instrument pass a string, allowing the ends to hang down. Introduce the catheter through the nostril into the mouth and draw the string, which is hanging from its end, out beyond the lips. To this attach a piece of sponge sufficiently large to fill up the opening in the posterior nares, completely filling its cavity. This method scarcely ever fails to control the most obstinate bleeding.

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Bleeding from Cut or Wound.

If bleeding occur from any part where a bone lies near the surface, as the head or face, it may generally be stopped by pressing firmly against the bone with the finger or a piece of cork, or by binding on tightly a hard pad. If this does not succeed, lift up each edge of the wound and examine carefully to see if any small stream of blood is spouting out in jets. If so, an artery is wounded, and the point of small forceps or tweezers must be dipped in where the jets come from, the spouting mouth taken hold of and drawn out, and a strong silk thread passed round it and tied below the forceps. The white and gaping mouth of the vessel may then be seen.

If the bleeding be profuse from an arm, the whole current of blood to that limb must be cut off, which may be done by some person pressing a thumb firmly into the neck behind the middle of the collar bone. This will dam up the blood in the great artery of the arm as it comes out of the chest. The handle of a door-key, wrapped in several folds of linen, may be pressed upon the place for a long time until medical assistance can be had. Dangerous bleeding from the thigh or leg may often be stopped by pressing the great artery just below the crease of the groin. If the bleeding be below the middle of the upper arm, or middle of the thigh, pass a handkerchief once or twice around the limb, as far above the wound as possible, and tie it loosely. Slip a stiff stick under this and turn it round, like the handle of an auger, until the handkerchief becomes so tight as to stop the bleeding. The tight bandage tied round the limb may be an injury if long continued. Let there be no delay in sending for the doctor.

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Burns and Scalds.

A burn is the effect of concentrated heat acting upon living tissues. The effects are inflammation and sometimes complete disorganization and destruction of the parts.

A scald is an injury produced by applying hot water or other fluid to the skin or mucous membrane. The natural temperature of the human body is ninety-eight degrees; that of boiling water two hundred and twelve degrees. Bringing the skin in contact with a fluid heated so far above it, produces redness and pain, and when nothing is done instantly to ward off the injury, the scarf skin is raised from the true skin in the form of a blister filled with water.

The degree of danger from a burn or scald depends upon the extent of the injured surface and also upon the depth of the injury. An extensive burn or scald may prove fatal in a few hours, the patient never rallying from the first prostration. These injuries are most dangerous when upon the head, neck, chest and belly. Old persons, and those who are feeble and have shattered constitutions, will sink under burns and scalds from which robust persons will suffer but little.

In simple burns which do not involve the true skin, very little treatment is necessary.

Prepared lard, that is to say lard without salt, is an admirable remedy for burns and scalds. All that has to be done is to spread the lard either on pieces of old linen rag or on lint and then to apply them smoothly to the parts affected, keeping them in their places by means of bandages.

Another valuable remedy for burns is carron oil, which is made by mixing equal parts of linseed-oil and lime-water in a bottle, and shaking it up well before using it.

When the true skin is partially or completely destroyed, a thick layer of flour may be placed over the burned surface and covered with cotton. I have seen the best results from the employment of flour and carron oil, and prefer them over all others for loosening the flour when it is to be taken off. Poultices are useful. Whatever dressing is employed, it should not be disturbed until separated by the exudation underneath, or unless foul odors arise. In changing, every particle should be carefully removed and the parts thoroughly washed with some disinfectant liquid, such as solution of carbolic acid, 1 to 80.

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Catalepsy.—Trance.

Catalepsy, or what is more generally known as trance, is a sudden spasmodic suspension of the senses of volition, in which the limbs become rigid, preserving a fixed position, no matter how uncomfortable or painful. The patient retaining exactly the same attitude as when seized, and if during the attack the position of the limbs be varied, they will remain as placed. The mind is apparently so absolutely engrossed in something outside of the person, that all control over, and union with the body seems lost, leaving it as it were dead; but after the paroxysm has passed there will generally be no recollection of what has transpired during the time that consciousness was suspended. In this respect persons in a cataleptic fit resemble those in a mesmeric state, or in the condition of insensibility produced by inhaling ether or chloroform. A peculiarity of this disease is that the thread of conscious life is taken up at the very point it was interrupted by the attack. An incomplete act will be completed; an unfinished sentence concluded at the end of the fit, though it should last for several minutes or perhaps hours.

CAUSES. The causes of this disease, to which women are more liable than men, are rarely local, but such as influence the whole body; catamenia, painful mental emotions, worms, an impaired digestion, may be cited as amongst the principal. Sometimes these attacks terminate in apoplexy, epilepsy, or melancholia.

TREATMENT. This must depend upon the probable cause of the disease. If the patient be of a full habit, cupping at the back of the neck, blisters, a seton or an issue, and purgatives should be given. But if in a weak, low state tonics and medicines to allay the spasms must be administered. During the attack mustard plasters should be applied to the hands and feet and pit of the stomach. Should the fit be a protracted one, cold water must be dashed over the head and face and strong ammonia applied to the nostrils. The following liniment may be beneficially used along the spine once a day: oil of hemlock, 2 drams; oil of vriganum, one dram; camphor, one dram; alcohol, 5 ounces. On recovery the patient should have nourishing diet, moderate exercise with sea bathing, or cold shower-baths. Mild tonics should also be taken to strengthen the system.

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Choking.

Some children eat much too fast; they bolt their food rather than eat it; if not carefully watched fill the mouth so full and swallow lumps of food in such hot haste as to choke themselves. Instantly put your finger into the throat and feel if the substance be within reach. If it is food, force it down, and thus liberate the breathing. Should it be a hard substance, thrust the finger and thumb as far back into the throat as possible, and if there be anything there attempt to pull it out at once. Whilst you are doing this, sometimes a violent fit of coughing will take place and expel it. If you cannot reach it give a good smart blow with the flat of the hand on the back just below the neck, which will often relieve the windpipe when obstructed. If that does not have the desired effect, tickle the throat with the finger so as to ensure the immediate vomiting and the subsequent ejection of the offending substance. Of the treatment of things that pass down at once into the stomach, such as pieces of money, buttons, and many articles of a like kind, which children, playing with frequently put into their mouth and sometimes swallow, little need be said, for they are seldom followed by any serious consequences. Sooner or later the foreign body passes through the alimentary canal with the food, and is thus got rid of. I may add, however, that in this case it is a very common practice to give repeated doses of aperient medicine; now unless the bowels should become confined, such a measure is rather injurious than useful.

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Cholera Morbus.

This disease is very apt to make its appearance in the night, and is very common during the prevalence of warm weather. It is also known as Bilious Cholera from the great amount of bile secreted and discharged.

CAUSES. These are principally due to excessive heat, especially in malarial districts, and sudden atmospheric changes; but dampness and wet feet will also tend to produce an attack.

SYMPTOMS. The disease, which commences with sickness and distress at the stomach, is followed by violent griping with severe cramps, especially in the bowels, attended by vomiting of a thin dirty, yellowish, whitish or greenish fluid, with discharges similar to that vomited. The nausea and distress generally continue between the intervals of purging and vomiting, at the same time the pain is intense. The pulse is rapid, soon becoming feeble and small, the tongue is dry, the urine highly colored. There is great thirst, yet at the same moment the skin is cool, but no drink can be retained on the stomach. The bilious discharges, which characterize this disease, distinguish it from diarrhœa.

TREATMENT. Put the patient to bed, and apply a large mustard plaster over the stomach and liver. Give liberal draughts of warm water, or flax-seed tea, which will clear out all the solid contents of the stomach and bowels. Then every half hour administer a tea-spoonful of compound powder of rhubarb and potassa, adding to each dose 5 to 10 drops of laudanum if necessary, until the vomiting and nausea are checked. Or else 10 drops of laudanum and 10 of spirits of camphor after each evacuation. To promote warmth of the body and of the stomach is of primary importance in this disease. Warm injections must be given frequently and hot bricks applied to the feet, while the whole body should be enveloped in warm flannels. The following is a valuable remedy in this disease, as also in diarrhœa: Syrup of orange peel, one ounce; acetate of morphia, 2 grains; tincture of cinnamon, 6 drams; tincture of cardomum, 6 drams. Mix, and give in doses of one tea-spoonful.

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Clothes Catching Fire.

It is perhaps unreasonable to look for presence of mind when this frightful accident occurs. Yet it is never more needed than at such a time. If you continue on your feet, the blaze will rapidly ascend and increase the chances of the chest being burned and of the flames being inhaled. If you run to and fro to seek relief from others not present, you will create a current of air that will fan the flame into a swifter work of destruction. The instant persons perceive their clothes to be on fire and in a blaze, they should slip off a coat or shawl and seize the nearest piece of carpet, large rug, cloths, blanket, cloak, or any other article, and wrapping them tight around you, throw yourself flat and roll over and over on the floor. If you do this with energy and effectually, you will put out the fire instantly. If it be a child or other person that is on fire, let any person present treat it in the same way. If the person is badly burnt before the fire is extinguished, as quickly as possible dash plenty of water upon it to prevent the burns from becoming deeper.

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Colic.

There are several varieties, arising from different causes, of this complaint, more commonly known as _gripes_, which are marked by severe pains in the parts about the navel, with distension or flatulence, but without purging or looseness of the bowels, and accompanied in some cases with nausea and vomiting.

CAUSES. Worms, cold, superabundance of vitiated bile, over-indulgence in indigestible or unripe food, or taking copious draughts of water on an overheated stomach, are among the principal causes which produce this malady, of which there are some seven distinct kinds recognized by medical men, the commonest forms of which we will now proceed to describe.

WIND OR FLATULENT COLIC.

This is a severe and distressing pain in the bowels, with sometimes a stoppage and swelling about the pit of the stomach.

The CAUSES are due to weakness in the digestive organs, eating indigestible food or unwholesome fruit, costiveness, and cold.

SYMPTOMS. There is a sense of fullness about the lower part of the stomach, accompanied with more or less pain, the wind—which is a characteristic of _this form_ of the complaint—moving from one part to another of the bowels, making a sort of rumbling noise. Pressure does not increase the pain as in the case of inflammation. The pulse is quick, and there is a slight fever attended with nausea.

TREATMENT. If the pain be caused by having eaten of anything indigestible, the stomach should at once be relieved by administering an emetic. If this does not have the desired effect, a dose of salts, salts and senna, or sweet tincture of rhubarb may be given. At all events the irritating substance must be expelled before the pains will subside. If there is no sickness of the stomach, a little essence of peppermint in water, or ginger in hot water, or brandy and hot water may be sufficient to expel the wind and give relief. If there be costiveness and the pain continues, the bowels should be moved by stimulating _injections_.

The following is well recommended. Castor oil, one ounce; salts of tartar, one-half ounce, and hot water, one pint. Mix well together.

BILIOUS COLIC.

This is a dangerous disease, and may be due to a morbid condition of the liver. The pain, which is chiefly about the navel, but sometimes extends over the whole body, is of a griping, tearing, twisting nature.

CAUSES. The disease may be due to long exposure to the cold, a torpid liver and skin, irritating substances taken into the stomach, vitiated bile, great unnatural heat with dampness, or malaria in the atmosphere, since it more commonly occurs in the autumn after a hot season.

SYMPTOMS. It comes and goes in paroxysms. Sometimes the abdomen is drawn in, at other times it is distended and stretched like a drum-head. The pain can, at the first, be relieved by pressure, but after a while the belly becomes tender to the touch. There is a thirst and heat and a discharge of bilious matter from the stomach. In the worst cases the pulse is small, the face pale, the features shrunken, and the whole body is covered with cold sweat. While the head is hot, the feet are cold, and in the advanced stages of the disease the action of the bowels is sometimes reversed, the feces being forced up through the mouth.

TREATMENT. Administer immediately an active purgative injection. Mix together four grains of pulverized camphor, 12 grains of cayenne, and one scruple of white sugar. Divide into four powders, and give one every fifteen minutes. This will relieve the pain. At the same time cover the whole belly with a large mustard poultice. The sickness of the stomach may be allayed by effervescing draughts, to which from 10 to 25 drops of laudanum have been added; or by hot draughts, with a like quantity of laudanum over the stomach and feet. A strong decoction of yam-root, drank freely, is a valuable remedy for relieving the intestinal spasms. Croton oil, given in one-drop doses done up in crumbs of bread, will often act as successfully as a purgative medicine; or castor oil and spirits of turpentine, in equal parts, in two large spoonful doses, may be taken before trying the croton oil. A warm bath and hot water bottles, or hot bricks rolled in flannel applied to the feet and sides, are good for inducing perspiration. Hot fomentations to the bowels should also not be forgotten.

Persons subject to this complaint may derive great benefit by taking after each meal one pill of the following recipe: extract of high cranberry bark, one scruple; cypridia, one scruple; aletridia, one scruple; pulv. cayenne, one scruple. Mix and make into pills. A sponge bath, rubbing the body well after it, should be taken daily, and also a reasonable amount of out-door exercise, without undue exposure to the sun.

PAINTERS’ COLIC.

Painters’ colic, known also as Devonshire colic, but more generally under the former designation, affects principally those engaged in the manufacture of white lead, or who employ it in their trade for mixing colors.

The name fully explains the CAUSE, which is due to slow absorption of the carbonate of lead into the system through the lungs, stomach and skin.

The SYMPTOMS of lead poisoning are, _as a rule_, gradual. The appetite becomes impaired, and there are transient pains in the umbilical parts, accompanied by languor, nausea, belching, obstinate costiveness, and vomiting of acrid bile. The attack which is paroxysmal in its nature, may be severe, or so mild as not to merit any notice, but by degrees the pains increase in severity and have a twisting character. The edges of the gums have a bluish tinge, and the belly becomes hard and contracted and tender to the touch. The pain, which may lessen at times, but never wholly leaves the patient as in other forms of colic, will in severe cases mount up to the chest, and down the arms, even affecting the bladder, making the passage of the urine painful. The face becomes pale and contracted, and a cold sweat suffuses the body.

TREATMENT. To relieve the pain and open the bowels, much the same course should be adopted as in Bilious Colic. Give at once a hot bath and a dose of from 20 to 30 drops of laudanum; afterwards one-fourth of the following mixture should be taken every four hours. Sulphate of magnesia, one ounce; powdered alum, two drams; tincture of opium, half a dram; water, six ounces. Alum is considered to have special curative powers where this disease has become chronic.

The following recipe is recommended to those exposed to the dangers of lead poisoning. Elixir vitriol, one-half ounce; tincture of prickly ash berries, one ounce; mix, and take a tea-spoonful in a gill of water three or four times a day.

Paralysis or palsy sometimes arises from this disease, but is in general confined to the wrists. Galvanism, with friction and shampooing should be applied, with chalybeate waters.

COLIC IN CHILDREN.

Young children are very liable to attacks of colic, owing to acidity in the stomach arising from injudicious over-feeding, or from giving them solid food at too early an age. They often suffer severely from the pains, throwing their little legs wildly about and screaming loudly.

TREATMENT. When the attack is due to costiveness, administer an injection of one table-spoonful of castor oil and one ounce of warm infusion of peppermint; or if the bowels require to be acted upon, give sweet tincture of rhubarb with a little soda in it. Paregoric on a small piece of sugar will generally give relief, but it is better not to use it, when simpler medicines for expelling the wind from the stomach and bowels and allaying the pains will answer the end in view.

Relief may also be frequently afforded the child by simply covering it with hot flannels and laying it on its belly across the knees, at the same time rocking it and gently tapping the back; but this must be done with great care, as otherwise it may tend to increase the infant’s sufferings.

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Cramps.

This is a sudden contraction of the muscles of the legs, thighs, stomach, and other parts of the body; the affected part being, as it were, “drawn into knots.” Drinking cold liquids when much heated and in a state of perspiration, or vice versa, weakness, excess in eating or drinking, and particularly overworking the muscles, are among the principal causes which induce an attack, which, when it affects the stomach, is a serious matter. Swimmers are very liable to cramps, which so often prove fatal to them. When the suffering is due to overstraining the muscles, the exercise must be moderated.

Rub the muscles well. This will help to bring it back to its natural condition, and if the affected muscle be in the leg, tie a bandage tightly above it, rubbing that part well with spirits of camphor, or laudanum.

When the attack occurs in the stomach, hot fomentations should be applied. Burnt brandy is also an excellent remedy, where the contracted muscles are situated internally. The bowels should be kept well regulated.

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Diarrhœa.—Looseness of the Bowels.

Frequent, copious, and thin or extremely liquid discharges point to a loose or relaxed condition of the bowels. Children are very liable, especially during the hot season, to this complaint, which often proves fatal to them.

The excessive discharges are due to a variety of CAUSES; as bad and unwholesome food, or food taken in large quantities, unripe fruit and other substances, which, remaining undigested in the stomach, act as irritants, until expelled; sudden changes of temperature; exposure to long continued heat, or malarial influences; the application of cold to the body producing congestion of the bowels; suppressed perspiration, and inflammation or ulceration of some portion of the bowels. With children the cause is very commonly due to eating unripe or unsound fruit, when naturally attention will be given to any attack, but not necessarily to its immediate suppression, as it may be only an effort of Nature to throw off from the system what is injurious to it; but the complaint must not be permitted to continue unchecked, as otherwise it may become serious.

SYMPTOMS. The attack may come on suddenly when due to cold or some undigested substance in the stomach; or there may be premonitory symptoms, as restlessness, disturbed sleep, and passing abdominal pains, and other signs indicative of indigestion, which may continue for some time. There is a feeling of distension and weight in the lower part of the stomach, attended by a rumbling noise in the bowels caused by the presence of wind. This feeling is relieved when an evacuation takes place, but returns when another is near at hand. Griping is frequently present, and the face is pale and dry and after a while becomes sallow. In addition to these symptoms the sufferer is troubled with nausea and vomiting, and if the purging be not speedily arrested, great exhaustion, accompanied by spasms and cramp, will follow.

Diarrhœa is distinguished from dysentery by the absence of blood in the discharges as also of fever, inflammation, contagion and straining at stool. As the disease progresses, the motions become very watery, the strength rapidly diminishes, great emaciation takes place, and dropsy generally ensues.