Chapter 17

BLEEDING FROM VARICOSE VEINS.--Serious and even fatal hemorrhage may occur from the bursting of a large varicose or "broken" vein. Should such an accident occur, the bleeding may be best controlled, until proper medical aid can be procured, by a tight bandage; or a "stick tourniquet," remembering that the blood comes toward the heart in the veins, and from it in the arteries. The best thing to prevent the rupture of varicose or broken veins is to support the limb by wearing elastic stockings, or a carefully applied bandage.

BURNS AND SCALDS.--There is no class of accidents that cause such an amount of agony, and none which are followed with more disastrous results.

1. By putting the burned part under cold water, milk, or other bland fluid, instantaneous and perfect relief from all pain will be experienced. On withdrawal, the burn should be perfectly covered with half an inch or more of common wheaten flour, put on with a dredging-box, or in any other way, and allowed to remain until a cure is effected, when the dry, caked flour will fall off, or can be softened with water, disclosing a beautiful, new and healthy skin, in all cases where the burns have been superficial. 2. Dissolve white lead in flaxseed oil to the consistency of milk, and apply over the entire burn or scald every five minutes. It can be applied with a soft feather. This is said to give relief sooner, and to be more permanent in its effects, than any other application. 3. Make a saturated solution of alum (four ounces to a quart of hot water). Dip a cotton cloth in this solution and apply immediately on the burn. As soon as it becomes hot or dry, replace it by another, and continue doing so as often as the cloth dries, which at first will be every few minutes. The pain will immediately cease, and after twenty-four hours of this treatment the burn will be healed; especially if commenced before blisters are formed. The astringent and drying qualities of the alum will entirely prevent their formation. 4. Glycerine, five ounces; white of egg, four ounces; tincture of arnica, three ounces. Mix the glycerine and white of egg thoroughly in a mortar, and gradually add the arnica. Apply freely on linen rags night, and morning, washing previously with warm castile soap-suds. 5. Take one drachm of finely powdered alum, and mix thoroughly with the white of two eggs and one teacup of fresh lard; spread on a cloth, and apply to the parts burnt. it gives almost instant relief from pain, and, by excluding the air, prevents excessive inflammatory action. The application should be changed at least once a day. 6. M. Joel, of the Children's Hospital, Lausanne, finds that a tepid bath, containing a couple of pinches of sulphate of iron, gives immediate relief to young children who have been extensively burned. In a case of a child four years old, a bath repeated twice a day--twenty minutes each bath--the suppuration decreased, lost its odor, and the little sufferer was soon convalescent. 7. For severe scalding, carbolic acid has recently been used with marked benefit. It is to be mixed with thirty parts of the ordinary oil of lime water to one part of the acid. Linen rags satured in the carbolic emulsion are to be spread on the scalded parts, and kept moist by frequently smearing with the feather dipped in the liquid. Two advantages of this mode of treatment are, the exclusion of air, and the rapid healing by a natural restorative action without the formation of pus, thus preserving unmarred and personal appearance of the patient--a matter of no small importance to some people.

CHOKING.--In case of Choking, a violent slap with the open hand between the shoulders of the sufferer will often effect a dislodgment. In case the accident occurs with a child, and the slapping process does not afford instant relief, it should be grasped by the feet, and placed head downwards, and the slapping between the shoulders renewed;

but in case this induced violent suffocative paroxysms it must not be repeated. If the substance, whatever it maybe, has entered the windpipe, and the coughing and inverting the body fails to dislodge it, it is probable that nothing but cutting open the windpipe will be of any avail; and for this the services of a surgeon should always be procured. If food has stuck in the throat or gullet, the forefinger should be immediately introduced; and if lodged at the entrance of the gullet, the substance may be reached and extracted, possibly, with the forefinger alone, or may be seized with a pair of pincers, if at hand, or a curling tongs, or anything of the kind. This procedure may be facilitated by directing the person to put the tongue well out, in which position it may be retained by the individual himself, or a bystander by grasping it, covered with a handkerchief or towel. Should this fail, an effort should be made to excite retching or vomiting by passing the finger to the root of the tongue, in hopes that the offending substance may in this way be dislodged; or it may possibly be effected by suddenly and unexpectedly dashing in the face a basin of cold water, the shock suddenly relaxing the muscular spasm present, and the involuntary gasp at the same time may move it up or down. If this cannot be done, as each instant's delay is of vital importance to a choking man, seize a fork, a spoon, a penholder, pencil, quill, or anything suitable at hand, and endeavor to push the article down the throat. If it be low down the gullet, and other means fail, its dislodgment may sometimes be effected by dashing cold water on the spine, or vomiting may be induced by an emetic of sulphate of zinc (twenty grains in a couple of tablespoonfuls of warm water), or of common salt and mustard in like manner, or it may be pushed into the stomach by extemporizing a probang, by fastening a small sponge to the end of a stiff strip of whalebone. If this cannot he done, a surgical operation will be necessary. Fish bones or other sharp substances, when they cannot be removed by the finger or forceps, may sometimes be dislodged by swallowing some pulpy mass, as masticated bread, etc. Irregularly shaped substances, a plate with artificial teeth for instance, can ordinarily be removed only by surgical interference.

COLIC.--Use a hot fomentation over the abdomen, and a small quantity of ginger, pepermint or common tea. If not relieved in a few minutes, then give an injection of a quart of warm water with twenty or thirty drops of laudanum, and repeat it if necessary. A half teaspoonful of chloroform, in a tablespoonful of sweetened water, with or without a few drops of spirits of lavender or essence of peppermint, will often give prompt relief.

CONVULSIONS.--In small children convulsions frequently happen from teething, sometimes from worms or from some irritating substance within the stomach or bowels, and sometimes from some affection of the brain.

When a child has convulsions, place it immediately in a warm or hot bath, and sponge its head with cold water. Then apply a hot mustard plaster to the wrists, ankles and soles of the feet, or, in case a plaster cannot be obtained, apply a cloth wrung out of hot mustard water. Allow these to remain until the skin reddens, and use care that the same do not blister. After the fit has subsided, use great care against its return by attention to the cause which gave rise to it.

Convulsions in adults must be treated in accordance with the manner which gave rise to them. During the attack great care should be taken that the party does not injure himself, and the best preventive is a cork or a soft piece of wood, or other suitable substance, placed between the teeth to prevent biting the tongue and cheeks: tight clothing must be removed or loosened; mustard poultices should be applied to the extremities and over the abdomen; abundance of fresh air should be secured by opening windows and doors, and preventing unnecessary crowding of persons around; cold water may be dashed on the face and chest; and if there be plethora, with full bounding pulse, with evidence of cerebral or other internal congestion, the abstraction of a few ounces of blood may be beneficial.

CRAMP.--Spasmodic or involuntary contractions of the muscles generally of the extremities, accompanied with great pain. The muscles of the legs and feet are the most commonly affected with cramp, especially after great exertion. The best treatment is immediately to stand upright, and to well rub the part with the hand. The application of strong stimulants, as spirits of ammonia, or of anodines, as opiate liniments, has been recommended. When cramp occurs in the stomach, a teaspoonful of sal volatile in water, or a dram glassful of good brandy, should be swallowed immediately. When cramp comes on during cold bathing, the limb should be thrown out as suddenly and violently as possible, which will generally remove it, care being also taken not to become flurried nor frightened, as presence of mind is very essential to personal safety on such an occasion. A common cause of cramp is indigestion, and the use of acescent liquors; these should be avoided.

CUTS.--In case the flow of blood is trifling, stop the bleeding by bringing the edges of the wound together, if the flow of blood is great, of a bright vermillion color, and flows in spurts or with a jerk, an artery is severed, and at once should pressure be made on the parts by the finger (between the cut and the heart), until a compress is arranged by a tight ligature above the wounded part. Then the finger may be taken off, and if the blood still flows, tighten the handkerchief or other article that forms the ligature, until it ceases. If at this point the attendance of a physician or surgeon cannot be secured, take strong silk thread, or wax together three or four threads and cut them into lengths of about a foot long. Wash the parts with warm water, and then with a sharp hook or small pair of pincers in your hand, fix your eye steadfastly upon the wound, and directing the ligature to be slightly released, you will see the mouth of the artery from which the blood springs. At once seize it, draw it out a little while an assistant passes a ligature round it, and ties

it up tight with a double knot. In this way take up in succession every bleeding vessel you can see or get hold of. If the wound is too high up in a limb to apply the ligature do not lose your presence of mind. If it is the thigh, press firmly on the groin; if in the arm, with the band-end or ring of a common door-key make pressure above the collar bone, and about its middle, against its first rib, which lies under it. The pressure should be continued until assistance is procured and the vessel tied up. If the wound is on the face, or other place where pressure cannot effectually be made, place a piece of ice directly over the wound allowing it to remain there until the blood coagulates, when it may be removed, and a compress and bandage be applied.

After the bleeding is arrested the surrounding blood should be cleared away, as well as any extraneous matter then bring the sides of the wound into contact throughout the whole depth, in order that they may grow together as quickly as possible, retaining them in their position by strips of adhesive plaster. If the wound be deep and extensive, the wound itself and the adjacent parts must be supported by proper bandages. The position of the patient should be such as will relax the skin and muscles of the wounded part. Rest, low and unstimulating diet, will complete the requirements necessary to a speedy recovery.

HOW TO DISTINGUISH DEATH.--As many instances occur of parties being buried alive, they being to all appearance dead, the great importance of knowing how to distinguish real from imaginary death need not be explained. The appearances which mostly accompany death, are an entire stoppage of breathing, of the heart's action; the eyelids are partly closed, the eyes glassy, and the pupils usually dilated; the jaws are clenched, the fingers partially contracted, and the lips and nostrils more or less covered with frothy mucus, with increasing pallor and coldness of surface, and the muscles soon become rigid and the limbs fixed in their position. But as these same conditions may also exist in certain other cases of suspended animation, great care should be observed, whenever there is the least doubt concerning it, to prevent the unnecessary crowding of the room in which the corpse is, or of parties crowding around the body; nor should the body be allowed to remain lying on the back without the tongue being so secured as to prevent the glottis or orifice of the windpipe being closed by it; nor should the face be closely covered; nor rough usage of any kind be allowed. In case there is great doubt, the body should not be allowed to be inclosed in the coffin, and under no circumstances should burial be allowed until there are unmistakable signs of decomposition.

Of the numerous methods proposed as signs for real death, we select the following: 1. So long as breathing continues, the surface of a mirror held to the mouth and nostrils will become dimmed with moisture. 2. If a strong thread or small cord be tied tightly round the finger of a living person, the portion beyond the cord or thread will become red and swollen--if dead, no change is produced. 3. If the hand of a living person is held before a strong light a portion of the margin or edges of the fingers is translucent--if dead, every part of it is opaque. 4. A coal of fire, a piece of hot iron, or the flame of a candle, applied to the skin, if life remains, will blister--if dead it will merely sear. 5. A bright steel needle introduced and allowed to remain for half an hour in living flesh will be still bright--if dead, it will be tarnished by oxydation. 6. A few drops of a solution of atropia (two grains to one-half ounce of water) introduced into the eye, if the person is alive, will cause the pupils to dilate--if dead, no effect will be produced. 7. If the pupil is already dilated, and the person is alive, a few drops of tincture of the calabar bean will cause it to contract--if dead, no effect will be produced.

DISLOCATIONS.--These injuries can mostly be easily recognized; 1. By the deformity that the dislocation gives rise to by comparing the alteration in shape with the other side of the body. 2. Loss of some of the regular movements of the joints. 3. In case of dislocation, surgical aid should be procured at once. While waiting the arrival of a physician, the injured portion should be placed in the position most comfortable to the patient, and frequent cold bathing or cloths wrung out of cold water, applied to the parts affected, so as to relieve suffering and prevent inflammation.

FOREIGN BODIES IN EARS.--Great care should be taken in removing foreign bodies from the ear, as serious injury may be inflicted. Most foreign bodies, especially those of small size, can be easily removed by the use of a syringe with warm water, and in most cases no other means should be used. Should the first efforts fail, repeat the operation. A syringe throwing a moderately small and continuous stream is the best adapted for the purpose, and the removal may generally be facilitated by inclining the ear downward while using the syringe. Severe inflammation may be excited, and serious injury done, by rash attempts to seize a foreign body in the ear, with a forceps or tweezers, or trying to pick it out with a pin or needle, or with an ear scoop. Should it be necessary from any cause to use instruments, great care should be observed, and but very little force exerted. It has lately been recommended, when foreign bodies cannot be removed by syringing the ear, to introduce a small brush or swab of frayed linen or muslin cloth, or a bit of sponge, moistened with a solution of glue, and keep it in contact with the foreign body until the glue adheres, when the body may be easily removed.

INSECTS IN THE EAR.--Insects in the ear may be easily killed by pouring oil in the ear, after which remove by syringing. (See foreign bodies in ear.)

TO REMOVE HARDENED EAR WAX.--Hardened ear wax may be softened by dropping into the ear some oil or glycerine, and then syringing. (See foreign bodies in ear.)

FOREIGN BODIES IN EYE.--To remove small particles from the eye, unless they have penetrated the globe, or become fixed in the conjunctiva, do as follows:

Grasp the upper lid between the thumb and forefinger, lift it from the eyeball, and having drawn it down as far as possible outside the lower lid, let it slide slowly back to its place, resting upon the lower lid as it goes back; and then wipe the edges of the lids with a soft handkerchief to remove the foreign substance. This may be repeated a number of times, if necessary, without injury. Should this means fail, evert the lids and remove the foreign substance, by touching it lightly with the fold of a handkerchief, or with the point of a roll of paper made like a candle-lighter; or, if necessary, with a small pair of forceps. A drop of sweet oil instilled in the eye, while perfectly harmless, provokes a flow of tears that will frequently wash away any light substance.

Bits of metal, sharp pieces of sand, etc. sometimes penetrate the globe of the eye, and, unless removed, may excite so much inflammation as to destroy the eye. They should he removed by a competent surgeon.

FAINTING.--Lay the person who has fainted in a current of air, or in

such a position that the air from an open window or door will have full play upon the face. Do not allow parties to crowd closely around, but give the sufferer plenty of room. Recovery will take place in a few minutes. The clothes also may be opened, and cold water sprinkled upon the face, hands and chest; and some pungent substance, as smelling salts, camphor, aromatic vinegar, etc., may be applied to the nostrils; and as soon as able to swallow, a little fresh water, or spirits and water, may be given. Persons who faint easily should avoid crowded rooms and places where the air is close.

FITS.--See Convulsions.

CLOTHING ON FIRE.--If a woman's clothes catch on fire, let her instantly roll herself over and over on the ground. In case any one be present, let them throw her down and do the like, and then wrap her up in a table-cloth, rug, coat, or the first woolen article that can be found.

FRACTURES.--As we can only give general rules for treating the various fractures, we would advise any one suffering from such to immediately apply to the nearest surgeon, and not rely upon an inexperienced party.

FROST-BITE.--Place the party suffering in a room without fire, and rub the frozen or frosted parts with snow, or pour ice-water over them until sensation begins to return. As soon as a stinging pain is felt, and a change of color appears, then cease the rubbing, and apply clothes wet with ice-water, and subsequently, if active inflammation follow and suppuration results, a solution of carbolic acid in water, one part to thirty, should be applied. If mortification set in, amputation is generally necessary. Where persons suffer from the constitutional effects of cold, hot stimulants should be given internally, and the body rubbed briskly with the hands and warm flannel.

POISONS, THEIR SYMPTOMS AND ANTIDOTES.--When a person has taken poison, the first thing to do is to compel the patient to vomit, and for that purpose give any emetic that can be most readily and quickly obtained,

and which is prompt and energetic, but safe in its action. For this purpose there is, perhaps, nothing better than a large teaspoonful of ground mustard in a tumblerful of warm water, and it has the advantage of being almost always at hand. If the dry mustard is not to be had, use mixed mustard from the mustard pot. Its operation may generally be facilitated by the addition of a like quantity of common table salt. If the mustard is not at hand, give two or three teaspoonfuls of powdered alum in syrup or molasses, and give freely of warm water to drink; or give ten to twenty grains of sulphate of zinc (white vitriol), or twenty to thirty grains of ipecac, with one or two grains of tartar emetic, in a large cup of warm water, and repeat every ten minutes until three or four doses are given, unless free vomiting is sooner produced. After vomiting has taken place, large draughts of warm water should be given the patient, so that the vomiting will continue until the poisonous substances have been thoroughly evacuated, and then suitable antidotes should be given. If vomiting cannot be produced, the stomach-pump should be used. When it is known what particular kind of poison has been swallowed, then the proper antidote for that poison should be given, but when this cannot be ascertained, as is often the case, give freely of equal parts of calcined magnesia, pulverized charcoal, and sesquioxide of iron, in sufficient quantity of water. This is a very harmless mixture, and is likely to be of great benefit, as the ingredients, though very simple, are antidotes for the most common and active poisons. In case this mixture cannot be obtained, the stomach should be soothed and protected by the free administration of demulcent, mucilaginous or oleaginous drinks, such as the whites of eggs, milk, mucilage of gum arabic, or slippery elm bark, flaxseed tea, starch, wheat, flour, or arrow-root mixed in water, linseed or olive oil, or melted butter or lard. Subsequently the bowels should be moved by some gentle laxative, as a tablespoonful or two of castor oil, or a teaspoonful of calcined magnesia; and pain or other evidence of inflammation must be relieved by the administration of a few drops of laudanum, and the repeated application of hot poultices, fomentations and mustard plasters. The following are the names of the articles that may give rise to poisoning, most commonly used, and their antidote:

MINERAL ACIDS--SULPHURIC ACID (OIL OF VITRIOL), NITRIC ACID (AQUA FORTIS), MURIATIC ACID (SPIRITS OF SALTS).--Symptoms: Acid, burning taste in the mouth, acute pain in the throat, stomach and bowels; frequent vomiting, generally bloody, mouth and lips excoriated, shriveled, white or yellow; hiccough, copious stools, more or less bloody, with great tenderness in the abdomen; difficult breathing, irregular pulse, excessive thirst, while drink increases the pain and rarely remains in the stomach; frequent but vain efforts to urinate; cold sweats, altered countenance; convulsions generally preceding death; nitric acid causes yellow stains; sulphuric acid, black ones. Treatment: Mix calcined magnesia in milk or water to the consistence of cream, and give freely to drink a glassful every couple of minutes, if it can be swallowed. Common soap (hard or soft), chalk, whiting, or even mortar from the wall mixed in water, may be given, until magnesia can be obtained. Promote vomiting by tickling the throat, if necessary, and when the poison is got rid of, flaxseed or elm tea, gruel, or other mild drinks. The inflammation which always follows wants good treatment to save the patient's life.

VEGETABLE ACIDS--ACETIC, CITRIC, OXALIC, TARTARIC.--Symptoms: Intense burning pain of mouth, throat and stomach; vomiting blood which is highly acid, violent purging, collapse, stupor, death.

OXALIC ACID is frequently taken in mistake for Epsom salts, to which in shops it often bears a strong resemblance. Treatment: Give chalk or magnesia in a large quantity of water, or large draughts of lime water. If these are not at hand, scrape the wall or ceiling, and give the scrapings, mixed with water.