Chapter 28

COMMON AILMENTS AND EMERGENCIES

This chapter describes a few home treatments for the relief of slight ailments and injuries, together with some measures that may be employed in emergencies. For more extended instructions in these subjects the student should consult the Red Cross Text-book on First Aid.

CONDITIONS IN WHICH THE NERVOUS SYSTEM IS INVOLVED

HEADACHE.--Headache is not a disease in itself, but a symptom common to many different disorders. Among the abnormal conditions often causing headaches are fatigue, eyestrain, indigestion, constipation, neuralgia, rheumatism, anæmia, acute infections, and other disorders. Treatment should consist in finding the cause and removing it if possible; clearly no one remedy can cure so many different causes. A physician should be consulted if headaches are of frequent occurrence, but in many cases rest and attention to other hygienic requirements are all that is needed. During an attack of headache a hot foot bath may give relief, or a mustard paste or cold applications on the back of the neck, or an ice bag or cold compress on the forehead.

SLEEPLESSNESS, like headache, has many possible causes, and effective treatment consists in finding and removing them. Pain or discomfort of any kind, fatigue, overwork, and worry are common causes. Sleeplessness easily becomes a habit that may persist after its cause has been removed; hence a person who has formed the habit of sleeplessness should patiently strive to break the old habit and to substitute a better. A careful hygienic régime is essential for the patient, exercise in the open air, and cultivation of a hopeful and tranquil spirit. The diet should be liberal, but light and unstimulating; tea and coffee should be omitted, certainly during the latter part of the day. The patient should spend rather a dull evening, avoiding excitement and mental exertion that is difficult, even though pleasurable. He should retire early. A hot tub or foot bath, and a hot drink at bed time may help to produce sleep. The bedroom should be dark, cool, and well ventilated, the bed comfortable and the covers light but warm. The patient should be told that rest is the most important thing for him, and that he should not try too hard to sleep nor worry if unsuccessful. The patient should try to banish from his mind, at bed time, thoughts that are distressing, and even those that are especially interesting. By using patience and persistence most persons can regain the power of sleeping even when habits of sleeplessness have been long established.

FAINTING is a partial or total loss of consciousness due to a diminished supply of blood in the brain. It may follow bleeding, exhaustion from heat, fatigue from prolonged standing and the like, or strong emotional disturbance, like fear or surprise. Fainting is less common than it formerly was; it now occurs most frequently among persons suffering from anæmia, heart weakness, or special susceptibility.

Symptoms of fainting are pale face, cold perspiration, rapid, feeble pulse, and shallow, sighing respiration. Treatment consists in removing the patient into cool, fresh air, applying cold water to the face and keeping the head low. For a person who feels faint but has not lost consciousness, this treatment will probably prove sufficient; if, however, he becomes unconscious, place him so that the head is lower than the body, loosen the clothing, especially the clothing about the neck, apply cold water to the face and chest, and see that fresh air is plentiful. When the patient is sufficiently conscious to swallow, give a teaspoonful of aromatic spirits of ammonia in half a glass of water and keep him quiet until he has entirely recovered.

A person who is unconscious from any cause always requires immediate attention. In emergency work elevate the patient's head if his face is flushed, and keep it low if his face is pale. Do not try to arouse an unconscious patient by shaking him and calling to him, in the first place because it is useless to do so, and in the second, because consciousness will return spontaneously if his condition improves.

CONVULSIONS.--In every case of convulsions a doctor is needed at the earliest possible moment. Convulsions in adults are very serious; in babies and small children although serious they are less alarming, since they may follow comparatively slight disturbances, particularly disturbances of digestion.

Treatment for babies and children with convulsions consists first in keeping the child as quiet as possible, and next in measures to draw blood from the brain toward the surface of the body. The child should first be undressed, moving him as little as possible, and put to bed between warm blankets. Cold should be applied to his head by a compress or ice bag, and hot water bag should be placed near his feet. An enema should then be given. A warm tub bath is sometimes used to apply heat, if the convulsion has not subsided by the time the child is undressed. If the bath is given the temperature of the water should not be above 106°, and should be tested by a thermometer. If no thermometer is available, the water should be tested with the elbow rather than the hand, and cold water should be added if it feels uncomfortably warm. There is great danger of scalding a child during the excitement inevitably caused by a convulsion.

Although haste is needed when a child has convulsions, yet quiet is essential, since the slightest movement tends to increase the convulsions or to start them again. As soon as the convulsions are over the child should be removed from the bath and put to bed between warm blankets. Even after the symptoms have completely subsided, the greatest care should be taken to keep the child quiet. He should be handled and disturbed as little as possible. The bath should be repeated if convulsions begin again. The doctor, when he comes, will probably order a dose of castor oil; and therefore, if it is impossible to obtain a doctor at once, the dose should be given.

SHOCK (in the medical sense of the word) or _collapse_, is a serious condition in which a patient's vitality and all his bodily processes are profoundly depressed. Generally shock occurs only after a severe injury or a long exhausting illness. Since, however, some persons are peculiarly susceptible to it, the possibility of shock must be kept in mind in treating even slight injuries. The probability of shock is somewhat increased if patients are allowed to see their own wounds. Injured persons should always sit or lie down while wounds, however slight, are dressed.

Symptoms of shock are pallor, pinched, anxious expression, dilated pupils, cold clammy skin, feeble breathing, and rapid, weak pulse. The patient may be mentally normal, or irrational, or unconscious, but more frequently he appears stupid, and though conscious, he pays no attention to what is going on. Unfortunately this condition is sometimes mistaken for sleepiness, and he is left alone to sleep just when active measures are most needed.

If a patient shows any symptom of shock the doctor should be summoned immediately, but no time should be lost in beginning treatment, since the condition may be critical. It should be remembered, however, that panic and confusion may alarm a patient who is conscious, and thus increase the shock. The patient should be covered warmly, and undressed under blankets, without exposure or avoidable moving. His head should be low, and as quickly as possible hot water bags should be placed near but not upon him. If the patient is conscious and able to swallow he should be given hot coffee or aromatic spirits of ammonia, one teaspoonful in half a glass of water. The legs and arms should be rubbed from the extremities toward the heart, but care should be taken to avoid touching or moving injured parts. The patient should stay in bed, warmly covered and closely watched for some time after he has apparently recovered.

Helping a patient into bed is not necessarily the first thing to be done in every case of sudden illness. Great harm may be done by the injudicious moving of injured persons, and often it is safer to make a person comfortable with pillows and blankets where he happens to be, certainly until a sufficient number of people can be found to lift him properly. Clothing should be removed carefully, and one should not hesitate to cut it away if undressing is painful or necessitates much moving.

STIMULANTS, in emergency work, are frequently misused. They should not be given when the head has been injured, when bleeding is profuse, or when the face is red and the pulse strong. Neither should attempts be made to give fluids of any kind to patients not sufficiently conscious to swallow. Safe stimulants to use are black coffee, tea, or aromatic spirits of ammonia. Alcoholic liquors should not be given unless prescribed by a physician.

SUNSTROKE AND HEAT EXHAUSTION are both caused by excessive heat either indoors or out, but they differ both in symptoms and in treatment.

Sunstroke or heat stroke, usually begins with acute pain in the head, followed almost immediately by loss of consciousness. The skin is dry and very hot, the face is red or purple, the pupils are dilated, the breathing is difficult, the pulse is slow, and the temperature high.

Treatment consists in sending for the doctor, removing the patient to a cool place, undressing him and applying cold, especially to the head and spine, or still better, placing him in a very cold bath. The body should be rubbed constantly in the direction of the heart. Stimulants should not be given.

Symptoms of heat exhaustion, on the other hand, resemble those of shock. The doctor should be summoned, and the patient should be removed to a cool and quiet place, where he should stay warmly covered in a reclining position. Stimulants should be given, hot water bags applied, and the other measures for treating shock should be employed.

CONDITIONS IN WHICH THE DIGESTIVE TRACT IS AFFECTED

NAUSEA AND VOMITING are frequently caused by injudicious eating, especially when a person is worried or fatigued. A doctor should be consulted if either one occurs often, or if vomiting is accompanied by pain, prostration, diarrhœa, fever, or other acute symptoms. A person who is nauseated should lie down in a cool, quiet place. Hot fomentations may be applied to the abdomen, or a mustard paste over the stomach. Soda mints or a teaspoonful of baking soda may be given dissolved in hot water, and unless diarrhœa is present a Seidlitz powder or other saline cathartic may be given. A large quantity of warm water may be given to wash out the stomach; it is more effectual if salt or mustard is added, in the proportion of one teaspoonful to a glass of water.

HICCOUGH, which is usually caused by digestive disturbances, is not serious in healthy people, and can generally be stopped by holding the breath, or by drinking water. If these measures are not effectual, salt or mustard in water as already described or a teaspoonful of the syrup of ipecac, may be given to produce vomiting. If the hiccough still continues, medical advice should be obtained.

DIARRHŒA is ordinarily caused by an infection, or by an offending substance in the intestines. The offending substance should be removed before attempts are made to check the diarrhœa. When a baby has diarrhœa four things should be done--all food should be withheld; boiled water should be given freely; bowel movements should be saved for the doctor to see; and unless a doctor can be found immediately, castor oil should be given, from one-half to one teaspoonful according to the age of the child. Similar treatment should be given to older children. Adults should take one tablespoonful of castor oil and drink boiled water freely, but they should take no food until the doctor comes.

CONSTIPATION has been discussed on pages 193 and 52.

COLIC is a sharp, intermittent pain in the abdominal region; it is caused in many instances by indigestion or chilling. The following remedies may relieve it: a hot water bag, an emetic, as salt or mustard in luke-warm water, a Seidlitz powder or other saline cathartic, soda mints, or a teaspoonful of syrup of ginger in hot water. Unless it feels sore or tender, the abdomen may be rubbed up, on the right side, across, just below the waist, and down, on the left side. Babies may be given a few teaspoonfuls of warm water, or an enema of salt and water.

Colic may be serious. The doctor should be summoned at once if the patient seems exhausted, if the pain is severe, if pain is increased rather than relieved by pressure, if the abdomen feels sore, especially on the right side, or if sharp abdominal pain is accompanied by fever, vomiting, and stubborn constipation. If the above-mentioned symptoms are present, no food, drink, or medicine should be given until the doctor comes.

CONDITIONS IN WHICH THE EYES OR EARS ARE AFFECTED

STYES generally accompany eyestrain or poor general health. The cause should be found and treated; and especial attention should be given to correcting eyestrain, indigestion, and constipation. Hot applications may be used, but if pus gathers, the stye should be treated by a physician.

FOREIGN BODIES IN THE EYE may sometimes be removed by blowing the nose violently, by yawning several times, or by drawing the upper lid down over the lower. The eye should not be rubbed. If it proves impossible to dislodge the object by these methods or by others similar, the patient's eyelid should be turned back in the following way: Let the patient sit with his head back in a low chair placed in a good light, and stand behind him holding his head between your side and upper arm. In this position the patient's head is held firmly while both of the operator's hands are free. Next draw down the lower lid, and remove the object, if visible, on the corner of a clean handkerchief. To turn back the upper lid, grasp the eyelashes firmly, draw the lid down, out, and then up over a match or pencil placed across the middle line of the lid and held in your other hand. Then wipe the object carefully away if it is visible.

Irritation that persists after the foreign body has been removed may be relieved by a cold compress continued for an hour or more, or by a drop or two of castor oil placed under the lid. If attempts to remove the foreign body prove unsuccessful, if the injury is severe, or if irritation continues after several hours, apply a cold compress, bandage it firmly so that the eyeball is kept at rest, and seek the aid of a physician.

DISORDERS AFFECTING THE EARS.--Permanent deafness may result from neglecting disorders of the ears. Ear-ache, discharge from the ear, swelling in or about it, pain or tenderness behind it, all require medical attention and no time should be lost in securing it. To relieve pain the patient may lie with the ear on an ice bag, but nothing whatever should be put into the ear before the doctor comes, except when an insect has entered the ear, and causes acute distress by the noise of its beating wings. If such an accident has occurred, the patient should lie on the unaffected side, and warm sweet oil should be dropped very gently into the affected ear by means of a medicine dropper. The insect generally drowns in the oil and floats to the opening of the ear canal. After it has been removed, the patient should lie on the affected side so that the oil may drain out of the ear.

No attempts should be made to remove foreign bodies from the ear or nose, unless they can be reached easily with the fingers. Hair pins, crochet hooks and similar instruments should never be used for this purpose. It is best for a doctor to remove foreign objects because unskillful attempts are likely to move them further in.

CONDITIONS IN WHICH THE SKIN IS AFFECTED

PRICKLY-HEAT, which affects babies and children more often than adults, is an eruption caused by heat and moisture, and aggravated by flannel underwear. It may be prevented by keeping the skin dry and cool, and it may be relieved by bathing the skin with alcohol and water, about one part of alcohol to three of water, and by using after the bath a powder made of two parts of starch to one of boracic acid, or any good talcum powder.

INSECT BITES AND STINGS.--The sting, if still in the wound, should first be removed, and then ammonia should be applied, since the poison is generally acid. Applications of cold water, alcohol and water, or wet salt may relieve the subsequent burning and itching, but ammonia is generally most effective.

IVY POISONING may be treated by applying cloths wet in a strong solution of baking soda or of boracic acid, or by applications of carbolized vaseline or ichthyol. Severe cases should have medical attention. Scratching and rubbing seem to spread the inflammation, and special care should be taken not to rub the face or eyes with infected hands. Susceptible people should avoid the plant if possible.

OTHER EMERGENCIES

CHILLS may be the result of infection or of exposure to cold. An early diagnosis of the trouble is so desirable that it is well to send for a doctor even when symptoms are not severe. If a person has a chill his temperature should be taken at once; fever and chill together probably indicate invasion by bacteria. When chills follow exposure to cold the patient should go to bed between warm blankets, his body should be briskly rubbed, and hot water bags and a hot drink should be given. If he prefers, he may take a hot bath before going to bed.

CROUP is caused by a spasmodic closure of the larynx so that breathing is impeded. The child who develops croup may have a slight cold, but frequently shows no symptoms until he wakes in the night with a hoarse ringing cough and difficult breathing. True croup, though often distressing, is seldom serious, even when the symptoms are so severe that the child appears to be partly suffocated. An emetic should be given at once, preferably syrup of ipecac, one teaspoonful followed by warm water, or ten drops every 15 minutes until the child vomits freely. Hot fomentations may be applied to the throat and chest in order to hasten relaxation of the muscular spasm, and water should be kept boiling near the bed in a teakettle or uncovered saucepan. The child should stay in a warm room during the following day.

Whenever a child develops a croupy cough his throat should be examined. A physician should be summoned if the throat is red and especially if the redness is associated with rise in temperature. Cases of diphtheria have been overlooked by neglecting such symptoms.

BLEEDING

In the vast majority of cases, bleeding can be stopped by elevating the injured part and applying pressure over the wound. One should, however, remember that loss of blood is not the only danger presented by an open wound, for pus-producing germs, if they make their entrance, may cause an infection which may be as serious as the bleeding itself. Hence in dealing with open wounds of any sort one should always keep in mind the danger of infection as well as the danger from loss of blood.

TREATMENT OF SLIGHT WOUNDS.--Loss of blood from slight wounds is seldom so serious as the danger of infection; therefore small cuts, pin pricks, scratches, etc. should be encouraged to bleed by pressure near the wound in order to expel the germs that may have entered. After the wound has bled a little, tincture of iodine should be applied by means of a cotton swab both to the wound itself and also to the surrounding skin.

After the wound has thus been disinfected it should be covered with a sterile dressing; a sterile or aseptic dressing is material in which all bacterial life has been destroyed. Gauze from a First Aid dressing or from a packet of sterile gauze should be used for this compress, or gauze may be cut from a sterile bandage. The compress serves two purposes: it protects the wound from infection, and if applied with pressure it checks further bleeding.

The compress should be securely bandaged in place, or its edges may be fastened with adhesive plaster or collodion. Neither of the two latter should cover the wound itself. The outside bandage may be changed when soiled, but the compress itself should not be disturbed until the wound has healed. It is a mistake to dress wounds oftener than necessary, since handling them always increases the chance of introducing germs. Most children, like Tom Sawyer, delight in wounds, but they should be prevented if possible both from inspecting and from exhibiting them.

If heat, swelling, redness, or pain develop in a wound after a day or two, a doctor should be consulted; and not a minute should be lost if the patient has a chill or if red streaks appear extending from the wound in the general direction of the heart. Until the doctor comes the wounded part should be elevated and covered with cold applications wet in alcohol 25%, or in a solution of common salt, a teaspoonful to a pint of water.

Several points should be remembered in dressing wounds. In the first place the mouth, which is full of germs, is not a good place for cut fingers. Moreover, wounds should not be touched by anything, especially the fingers, either washed or unwashed, nor should the scissors, fingers or other object be allowed to touch the surface of the dressing that is to be placed directly upon a wound. Unless they contain gross dirt wounds should not be washed with water, since washing introduces another chance of infection and accomplishes nothing except a tidy appearance, which is not essential. Furthermore, it should be remembered that exposure to the air will not infect a wound, and therefore time should be taken to find a suitable dressing. When a sterile dressing is quite impossible to obtain, the cleanest material available should be used; one of the best substitutes for a sterile dressing is the inner surface of a handkerchief or napkin that has not previously been unfolded since it was ironed. It is a common mistake to tie up a wound in the first article presented, which is usually a generous by-stander's soiled handkerchief. The same precautions in regard to cleanliness should be taken in dressing wounds that are known to be contaminated, since even into an infected wound it is possible to introduce more germs and more virulent ones.

NOSEBLEED usually stops of itself, but if it is obstinate the patient should sit erect with the head back, and cold compresses should be placed on the nose and at the back of the neck. Pressure should be made on the upper lip by means of the fingers, or by a firm roll of paper or cotton placed under the upper lip. Salt or vinegar in water, a teaspoonful of either one to a cup of water, may be snuffed up the nose. The treatment should be continued for ten or fifteen minutes, or until bleeding stops; if the bleeding persists a doctor is needed.

PROFUSE MENSTRUATION should be treated by keeping the patient quiet in bed with the head low and the feet slightly elevated. "Any marked increase, whether by amount, duration, or shortening of the interval between the periods ought to receive attention and be brought to the physician's notice" (Latimer). Painful menstruation may be relieved by rest in bed, mental as well as physical, by hot drinks and by the application of heat. Rest, and hygienic living persistently practised, will relieve most menstrual abnormalities. The common practice of using patent remedies and alcoholic liquors for disordered menstruation cannot be too strongly condemned.

OTHER INJURIES

SPRAINS.--A sprain is caused by twisting, stretching, or tearing the tissues about a joint. The first sharp pain comes from the injury to the tissues; subsequent pain is caused by the pressure of accumulated fluid. The other symptoms are those characteristic of inflammation.

When a sprain is slight, the affected part should be elevated and kept at rest for the first twenty-four hours. Either heat or cold should be applied, or heat and cold alternately; a good treatment is to soak the part in hot water and afterward to allow cold water to run upon it from the tap. Gentle rubbing with a circular motion helps to reduce the swelling. If the joint must be used it should be bandaged tightly.

Injuries to joints should never be neglected; and severe sprains always require medical attention, since in addition to the sprain a bone may be broken. A severely sprained joint should be elevated, treated with hot or cold applications, and kept at rest until it has been examined by a physician.

BRUISES.--Bruises need no attention unless they are extensive or painful. The skin should be kept clean and if possible unbroken, since injured tissues are less resistant to infection than tissues in their normal state. Applications of cold water or of equal parts of cold water and alcohol may relieve the pain, but cold should not be used upon bruises that are extensive. A compress bandaged tightly in place may help to prevent swelling and discoloration.

BURNS AND SCALDS.--Injuries from dry heat are called burns, and those from moist heat are called scalds. Both are painful, and both are dangerous if extensive or deep. Burns and scalds require medical attention if the injured area is extensive, if a large blister is formed, if the skin is destroyed or charred, and if symptoms of shock appear. Shock often follows burns or scalds even when the injury is comparatively slight.

Treatment of slight burns, where the skin is reddened but not destroyed, has for its main object the exclusion of air. One of the following may be applied: dry baking soda, or baking soda made into a paste with water, picric acid gauze moistened in water, boracic acid ointment, vaseline, sweet oil, or castor oil; if none of these is obtainable, lard, cream, the white of an egg or unsalted butter may be used. Old muslin or linen bandaged lightly in place, should be used to cover the burn.

The same treatment is used for sunburn, and also for small burns where blisters form. A blister, if it forms, should not be punctured; but if it is accidentally broken the skin of the blister should not be removed. It should be remembered that a broken blister is an open wound, and therefore liable to infection.

BRUSH BURN is a name given to injuries where the surface of the skin has been removed. They include the scraped arms and legs which are common accidents in childhood. In order to dress a brush burn, particles of dirt should first be removed preferably by means of forceps that have been boiled, and the surrounding skin should then be cleansed with soap and water. The injured part should next be flushed with sterile salt solution, made by boiling water five minutes and adding to it salt in the proportion of one teaspoonful to a pint of water. If the dirt is difficult to remove a soap compress should be applied. To prepare the compress several thicknesses of gauze or muslin should be boiled in a strong solution of castile or green soap for ten minutes. The compress should remain in place several hours, and may be repeated if necessary. After the wound has been thoroughly cleansed, it should be dressed with old muslin that has been saturated in castor oil or spread with boracic ointment.

EXERCISES

1. Name some common causes of headache and of sleeplessness, and outline rational treatment for each of these disorders.

2. Describe symptoms and treatment of shock; of fainting; of convulsions in children.

3. Describe the treatment of all disturbances of the digestive tract mentioned in this book.

4. What should be done if a foreign body has entered the eye? if one has entered the ear? What should be done for a person who has a stye? for a person with pain in or near the ear?

5. How would you treat a sprain?

6. Describe treatment for burns and scalds.

7. Distinguish between heat stroke and heat prostration, and tell what treatment should be given in each case.

8. What are the two principal dangers from slight wounds, and how should one guard against them? Show how you would dress a small cut.

9. What should you do for a person with nose bleed?

FOR FURTHER READING

American National Red Cross Text Book on First Aid--Lynch.

Immediate Care of the Injured--Morrow.

Prompt Aid to the Injured--Doty.