Chapter 14

EMERGENCIES AND ACCIDENTS

Few things are of greater importance, and nothing is more neglected than instructing school-children how to act in emergencies. Particularly is such knowledge of value in the country. In cities the need of understanding matters of this kind is not so great, since it is usually possible to secure at short notice some one capable of dealing with any situation that may arise. Children very quickly grasp knowledge of this character, and opportunities frequently offer for an actual demonstration of the proper remedies in the case of accidents. When the instructor speaks of cuts and burns they at once understand what is meant.

The most serious result of our neglect in this particular is that our children pass through life with the most meagre knowledge of the proper way in which to meet accidents of all sorts, for where they are not taught during their school days they, for the most part, remain ignorant of matters of this kind throughout their maturer years. It is much to be hoped--though this is somewhat of a digression--that the old unscientific and senseless system of teaching, which persists even in the present time to a considerable degree, may in the future give way to a more rational and practical plan of instruction--one that will deal with perceptible needs rather than abstractions.

The most common emergencies will now be taken up and considered in detail.

_Drowning._--The subject of drowning is one of especial interest in rural districts, since it is here that accidents of this kind are most apt to occur, and skilled attention is most difficult to obtain. It is of the utmost importance to remember that people may be resuscitated after having been under the water for considerable periods of time, and we should, therefore, look upon no ordinary cases as hopeless until the proper restorative measures have failed.

On removing the body from the water we should not waste time by attempting to drain the water from the victim's mouth, as the amount of this substance that enters the air-passages under such circumstances is so trifling that it may be entirely disregarded. The drowned person should be placed face down upon the ground with the head slightly turned to the left, and we should begin at once with artificial respiration.

_Artificial Respiration._--This is accomplished by the operator kneeling between the separated legs of the patient and placing his hands on the small of his back, the thumbs nearly meeting at the middle of the spine, and the other fingers spread out over the lower portion of the chest; the operator then sways his body downward and forward slowly, counting three during the movement, then quickly swinging backward releasing the pressure on the patient's chest; again count three and repeat the original movement. The pressure should be brought to bear from twelve to fourteen times a minute, and the movement should be kept up until the patient begins to show evidences of being restored, or until it is quite evident that life is extinct.

This system of artificial respiration was originated by Professor Schafer, as the head of a commission appointed by the British Government, and is now universally regarded as being by far the most satisfactory of all such methods.

In the accompanying figures are shown the positions assumed by the patient and operator while carrying on artificial respiration.

It should be remembered that the victims of accidents of this kind suffer considerably from lowering of the temperature of the body as a consequence of the long exposure to water, and we should, therefore, also direct our attention toward bringing about an immediate reaction by means of warm blankets and hot bottles, and by vigorous rubbing of the patient's body.

_Danger from Wounds._--Wounds may be produced by a great variety of objects, but chiefly, of course, by cutting instruments. Where they are caused by duller objects, producing more or less tearing and bruising of the tissues, they are more apt to be followed by infection with disease-producing germs than where smoothly cut, and consequently require greater care in treatment. Germs sufficient to produce death may be introduced into the body by the most minute wound; it is for example well known that fatal consequences have resulted from the bites of various insects, and the writer has personally seen a case where a pin-prick was followed by lockjaw and death. Such facts teach us that we should be careful in avoiding wounds of all kinds, and, that after they have been received, they deserve attention, however insignificant they may appear to be.

Wounds resulting from objects more or less covered with dirt are particularly dangerous, since under such circumstances the germs of lockjaw are apt to be introduced into the body, and fatal consequences not uncommonly ensue. It is astonishing how frequently the disease just referred to follows where a barefooted child sticks a dirty splinter or a rusty nail into its foot, and it cannot be too strongly urged that it is the duty of the parent in such instances to call in a competent physician at once. The reason that injuries of this kind are so apt to be followed by lockjaw is that the germ that produces the disease lives practically everywhere in the earth--being especially common in the rich soil of gardens and other highly fertilized earths; and the germs are so minute that thousands of them might be present on the point of a pin without being visible to the naked eye. The bacilli of lockjaw do not grow at all where exposed freely to the oxygen of the air, and as a consequence of this fact we rarely see the disease that they produce developing after slight superficial wounds; much more commonly the malady results from a wound made by some penetrating object, such as a splinter of wood, a nail, or a pin.

The lesson that these facts teach is that where wounds are small and deep it is the part of wisdom to cut them open freely in order that they may be cleansed as far as is possible, and at the same time allow the air to obtain free access to their deepest portions; a wound of this kind should not be sewn up, but should be left open and allowed gradually to heal up.

The reason why lockjaw so frequently follows wounds from the premature explosion of fireworks is that the paper used in fire crackers, etc., often contains the germs of the disease and is driven deeply into the tissues. In view of the very considerable mortality that yearly occurs among the children of this country it seems incomprehensible that our legislatures--which commonly exhibit such an uncontrollable desire to regulate their neighbors in every possible way--should not long ago have placed the ban on fireworks of all kinds.

_Treatment of Wounds._--The treatment of wounds necessarily depends to a considerable extent on their character and general severity: there are certain practices, however, that apply in all cases, and should, therefore, be resorted to wherever injuries of this kind occur. Where the wound is superficial the bleeding is as a rule trifling in character, and very quickly stops of its own accord. In other cases, particularly where deep, larger blood-vessels may be severed, and if they be of any considerable size, the hemorrhage will not cease until the subject becomes exceedingly weak, and in some instances the bleeding will go on until death results. Where bleeding is profuse, it may generally be assumed that one of the larger vessels has been cut, and under such circumstances it should be compressed until skilled assistance arrives. There is a popular but very erroneous impression that arteries can only be stopped by tying; as a matter of fact any one possesses sufficient strength in the fingers to pinch them enough to stop the hemorrhage. If possible, the operator should get his finger down into the wound, after which he can quickly discover the exact point where pressure stops the bleeding. One who is unaccustomed to surgical practices would, of course, hesitate at doing this, but it cannot be too strongly urged that a procedure of this character produces little or no pain after the finger is first introduced, and that no one should be deterred by foolish squeamishness from immediately doing that which in many instances can only save the life of the victim.

Where arteries are evidently bleeding--which may be inferred from the spurting character of the hemorrhage--a tight bandage above the seat of the wound, if on one of the extremities, will often be followed by a cessation of the bleeding, and where only small vessels are cut, a bandage tightly applied over the wound itself may accomplish a similar result. Under such circumstances the reader should be warned that it is not safe to leave a limb tightly bandaged in this way for any considerable length of time, as complete death of the part below may result. Where then a ligature is placed above or over a wound, it should be loosened cautiously every twenty or thirty minutes, and should be left off for a time. If the wounded artery begins to bleed, one should resort to local pressure upon it with the finger for five or ten minutes, after which the bandage may again be applied.

As soon as all bleeding has ceased, the wound should be thoroughly washed out by means of water that has been boiled and allowed to cool; the operation may be greatly assisted by using a rag or a piece of cotton that was boiled in the water. If there be grease or other dirt that does not readily come away soap may be freely used.

After the wound has been thoroughly cleansed, some sort of antiseptic had better be applied. Unquestionably the best of all of these is tincture of iodine, a small amount of which should be poured directly into the wound. A saturated solution of carbolic acid in water is also a fairly good disinfectant, and may be employed where the tincture of iodine cannot be obtained. A solution of corrosive sublimate in water--one part of the former to one thousand parts of the latter--is much used as an antiseptic by surgeons, but when placed directly in wounds has a tendency to cause much irritation, and is by no means so efficient as either of the disinfectants just referred to. In the country it is an old custom to use turpentine, or resins from several different species of pines; these are fairly efficient antiseptics, and should be employed where it is impossible to obtain those that are better. It should always be remembered that thorough washing out with boiled water and soap is in itself a procedure that will remove a considerable proportion of any germs that may have got into the wound, and that if carefully done, it is almost as efficient as the best antiseptic.

After the wound has been thoroughly cleansed by water and antiseptics, it should then be bandaged with a cloth that has been previously boiled and dried, if no regular surgical dressing is at hand. Every precaution should then be taken to prevent it being reopened. Collodion is sometimes used over small wounds, and is quite efficient in that it forms a coating over any surface upon which it is placed that is impermeable to both air and water. Small wounds that have been thoroughly cleansed and disinfected with tincture of iodine may be safely and satisfactorily closed by means of the substance just mentioned, but it should never be forgotten that the germ of lockjaw--which is the one, ordinarily, most to be dreaded in such injuries--lives and grows best in the absence of the oxygen of the air, and that a covering of collodion would materially assist in the development of this dreadful disease.

In those instances where pus forms in wounds, they should be at once reopened and allowed to drain. It very often follows after cuts--particularly if they be not properly cleansed--that a scab forms on the outside, holding beneath a greater or less amount of pus. The presence of the latter can generally be inferred by a wound presenting a red and angry appearance around its edges, and from swelling and pain. As soon as such a condition is observed, the scab should be thoroughly soaked in water and removed, and it is then necessary that the wound be kept open and allowed to drain freely until it heals up from the bottom. A failure to observe precautions of this kind may result in blood-poisoning, and finally even in death. After a wound begins to suppurate it does little good to put antiseptics into it, as they cause considerable irritation, and under no circumstances do they put an end to the pus formation. Open drainage of the wound, and keeping up the general health of the patient, are the only means that we possess of successfully combating conditions of this kind.

Inasmuch as we possess an antitoxin that unquestionably has the power of preventing lockjaw, if given sufficiently early, it is the part of wisdom to administer at once a sufficient dose of this substance to any child who has received a penetrating wound from some dirty object, or from the explosion of fire-crackers. Statistics show that under such circumstances lockjaw may be prevented in almost all cases. If we wait until the disease develops, the antitoxin is of no value.

_Care of Sprains._--The seriousness of sprains is very generally underestimated, and as a consequence many persons go through life with ankles that are abnormally weak, and even painful in bad weather, and in which there is a tendency to swell and become exceedingly troublesome after a slight wrench. In all true sprains there is more or less actual tearing of the ligaments that bind the joint together, and, if the injury be not properly treated and the joint thoroughly supported, complete recovery in many instances never takes place.

As soon as a sprain occurs the injured joint should be immersed in water just as warm as can be borne, and hot water should be from time to time added in order to keep the temperature sufficiently high. The bath should be continued for several hours--the longer the better. Thus the pain and swelling will be greatly reduced, and the tenderness which, in the beginning, is so excruciating, will largely disappear. The next step is to properly support the injured parts in order that unnecessary movement may be prevented, thus avoiding further tearing of the ligaments. This may be accomplished by means of various splints--the most popular being those made of plaster of Paris, or silicate of sodium, either of which will require the services of a physician in order to have them properly applied.

Within recent years a treatment has come much into vogue, which is exceedingly satisfactory, and has the advantage that it does not require the service of an expert in order to have it properly carried out. This consists in the application of strips of adhesive plaster to the skin over the seat of the injury and for some distance both above and below the joint affected. Ordinary sticking-plaster is not the best for this purpose, though in an emergency it might be used; much better is the so-called mole-skin plaster, which is much thicker, and does not require moistening before being applied. The plaster should be torn into strips about three-fourths of an inch wide and twelve to eighteen inches long. Where the ankle is the seat of the trouble, a strip is firmly applied to the back of the foot, beginning just behind the toes, and is brought around the ankle and carried up on to the calf of the leg--thus partially winding the plaster around the leg. The first strip having been applied, another is put on in a similar way, the edges of the latter overlapping those of the former. This is continued until one side of the ankle is fairly well covered, after which we may begin operations on the opposite side, carrying the strips around the leg in such a way as to meet and overlap those first put on. This process is continued until the entire joint is completely covered with the plaster. It is of the utmost importance that the foot be put in a natural position before we begin to apply the plaster, as, otherwise, it will be left in a constrained and uncomfortable position, which will do away largely with the good effects of the splint. Where carried out in the proper way it is in the highest degree astonishing to see how perfectly the joint is supported, with the effect that the use of the injured limb may be immediately resumed. The writer recalls having seen a young lady with a frightful sprain, who could not bear to touch her foot to the floor, improve to such an extent under the treatment as outlined that she was able to go to a ball and dance through the evening on the day the injury occurred.

Not only does the immediate resuming of the use of an injured limb, when treated in this way, appear not to be injurious, but the ultimate recovery seems actually hastened. After a day or so it is well to remove the plaster splint first applied and put on another, as the former has by this time usually ceased to fit the injured joint--owing to the diminution in the swelling. The splint may be changed three, four, or even five times, if deemed necessary, though two or three applications generally amply suffice. _This or some other splint should be kept on the injured joint for at least a month or six weeks, as otherwise complete recovery frequently fails to occur, with the permanent weakening of the joint as a consequence._

Of course it is always desirable to have a physician apply the splints for a sprain where this is feasible, but with a little care it may be done by any intelligent person who will observe closely the directions given. The plaster should be put on moderately tight, but the utmost care must be exercised in not carrying this to an extreme, as in such cases serious results might ensue. In order that it may be determined as to whether or not the splint is too tight, it is advisable to watch the patient's toes for some hours after the plaster is put on, and should they be found to be very cold, and particularly should they begin to show a dusky discoloration, it is evidence that the strips are exerting too much pressure, and they should be at once removed. Under such circumstances, in a half an hour or so, the splint could be reapplied with safety.

The mole-skin plaster, which is used in making the splint just referred to, may be obtained in rolls of any width from all druggists; and as the plaster keeps practically indefinitely, it should be in the medicine-closet of everyone living at a distance from skilled medical aid.

After a sprained ankle the patient should wear shoes that come well up above the injured joint, and they should be laced tightly until some time after all symptoms of trouble have disappeared; it would be on the safe side to wear shoes of this kind from six months to a year, depending upon the severity of the injury.

_Treating Bruises._--Bruises are not usually followed by serious consequences if properly treated. They result from injuries that tear the tissues beneath the skin to such a degree that hemorrhage from many minute blood-vessels occurs in the injured part. In the course of a few hours they often present a truly alarming appearance, being swollen and greatly discolored, but they are not as a rule followed by any permanent ill results. Where bruises are slight no treatment of any kind is required, as in a short time the effused blood is absorbed, and the part returns to a normal condition. Where more severe it is not a bad practice to cover them with flannels wrung out from hot water, the same being renewed from time to time, and the applications kept up for from six to twelve hours. Usually at the end of this time the soreness and swelling will have considerably abated, and the injured tissues quickly return to a normal condition.

_The reader should be warned that under no circumstances should the skin be opened, even though it may be quite obvious that there is a bluish mass of blood immediately beneath._ Where this mistake is made, infection of the injured tissues with the germs that produce pus inevitably results, and as a consequence the patient suffers with a discharging wound for a considerable period of time. In rare cases germs get into the injured parts without the skin having been opened, and there results under such circumstances a condition which closely resembles that of an ordinary abscess. The probability that this undesirable complication has arisen is shown by the swelling becoming greater and more painful some days after the injury has occurred, and under such circumstances a good physician should be at once consulted, as it will be necessary to make an incision into the diseased area.

_Soothing Burns._--One of the most common and painful of injuries are burns. Small superficial burns require no particular treatment. Where, however, they are of sufficient severity to merit attention, the simplest and best of all treatments is to immerse the diseased part in cold water, and here it should remain at least some hours, or until competent medical aid can be secured. Medical treatment of injuries of this kind is not particularly satisfactory, though there are some drugs that may be used with more or less benefit. Chief among them is picric acid, which may be applied by means of a cloth wrung out of a one per cent. solution of this substance in water. Another treatment which has some merit, and which has long enjoyed a certain vogue among both medical men and the laity, is a combination of equal parts of lime-water with either olive or linseed oil; this is called carron oil and is applied in the same way as the picric acid solution. All three of the remedies referred to act largely by preventing the access of air to the burned surface, and they, therefore, may be replaced by any bland and non-poisonous substance which accomplishes like results.

_Accidents from Heat and Cold._--The climate of the United States is characterized by extreme variations--there being over almost its entire extent during the winter months a series of "cold waves," during which excessively low temperatures are often experienced,--particularly in the northern and western portions of the country. During the summer, on the other hand, we have almost everywhere periods during which the temperature goes very high--often accompanied by excessive atmospheric moisture. As a consequence of these extremes in temperature it could only be expected that we would often experience bad effects, so that serious illness, and even death, occasionally result.

Of the two extremes, excessive heat is much the more dangerous, and is by far more frequently followed by fatal results--particularly in crowded cities. Fortunately for the dwellers in rural districts the precise conditions under which excessive heat is followed by serious consequences are not so frequently encountered as in the more populous centers, and as a result we find that serious ill effects from high temperatures are by no means so common in the former as in the latter. There are, however, two quite well defined and distinct morbid conditions that are the result of high temperatures, and inasmuch as they differ in their symptoms as well as in their treatment, it will be necessary to consider them separately.

_Sunstroke._--Sunstroke is characterized by a rapid onset, the patient usually complaining of an uncomfortable sense of burning heat and a feeling of dizziness and depression. Nausea, vomiting, and diarrhoea are common, frequently an intense headache, and sooner or later a muttering delirium. The patient's skin is dry and hot, the face is flushed, and the eyes suffused, and a thermometer will show a bodily temperature of from 105 deg. to 110 deg. or even 112 deg.F. In fatal cases it is usually some hours before the patient dies, though sometimes he succumbs almost instantly.

When attacked, the patient should at once be removed to some shady place, and should be held in a sitting posture against any suitable object that may be at hand. The clothing should be loosened at once, and every endeavor should be directed towards lowering the temperature of the victim. This is best done by pouring ice-water or the coolest water that can be secured freely over the entire body of the patient. This treatment should be continued until the temperature approaches the normal--the vigor of the measure employed gradually decreasing, as the patient shows signs of getting better. Improvement is shown by a gradual return of consciousness.

_Heat-Prostration._--Like true sunstroke, heat-prostration comes on with an extreme suddenness. The patient becomes suddenly dizzy, and sinks to the ground in a state of collapse. The skin is pale and cool, the pulse limp and weak, and the thermometer shows the temperature to be somewhat below normal. The patient should be laid on the ground in a cool, shady place, and stimulants at once given. By far the most efficient of them is a hypodermic injection of morphine and atropine, to which strychnine in appropriate doses may be added.

_Guarding against Sunstroke and Heat-Prostration._--Excessive heat is the basis of both of these conditions, but there are many contributing causes which play a more or less important part in their production. Notwithstanding the fact that they are regarded as being different, and that the treatment and symptoms of the two conditions vary widely, there can be no doubt that certain depressing influences, in every way similar, play an important part in their causation.

Foremost among such influences alcohol claims first place, and unquestionably not only predisposes to all diseases brought on by heat, but lends much greater gravity to an attack--the drunkard rarely recovering from true sunstroke, and frequently dying from the much less dangerous heat-prostration. It is said that the latter condition is particularly prone to occur after freely indulging in beer or other malt liquors. Not only does alcohol predispose to these morbid states, but other influences that depress the general vitality are more or less apt to predispose to the production of both, such as loss of sleep, overwork, worry, excessive eating, and insufficient food. The danger is greater when there is excessive moisture in the air, so that at such times we should particularly avoid excesses of all kinds, and as far as possible, keep out of the direct rays of the sun.

_Frost-bite._--In the extreme northern and northwestern portions of the United States frost-bite is not uncommon in winter. The part attacked becomes suddenly bloodless, presenting much the appearance of the skin after death. The victim is usually not aware of the fact as at first there is no pain. As soon as a condition of this kind is observed,--and in cold countries persons are quick to inform the victim when they notice it,--the place should be vigorously rubbed with a piece of ice, or with a handful of snow, and this should be continued until the circulation again returns as evidenced by the parts becoming reddened. A rapid warming of the affected parts is not advisable, the result being not unlike that of a burn.

_Chilblains._--Many persons suffer during the winter from chilblains--this being a state in which more or less pain and itching is produced in a part as the result of poor circulation. Such a condition is usually the result of a combination of cold with the affected part being more or less compressed, and as a consequence, we find that troubles of this kind are more frequently in the feet--particularly where tight shoes are worn. The remedy for troubles of this character is to wear loose-fitting shoes, and to thoroughly protect the parts by appropriate woolen socks. It is particularly of importance to change the socks often, since as soon as they become moistened with perspiration a tendency to a recurrence of the trouble is very great. Drugs are of no particular use in conditions of this kind. Chilblains are more commonly suffered in Europe than in America. One young American lady in Paris acquired them one winter, and "knowing no better," as she told the writer, cured herself by "boiling the chilblains"--soaking her feet in the hottest water she could endure. The affliction did not return; and the novel recipe was delightedly followed by all the art-students of the neighborhood.

_Blisters._--Small blisters on the feet are not uncommon as the result of wearing tight, or ill-fitting shoes. Wherever possible, they should be quickly relieved from all compression, and should under no circumstances be opened.

The treatment is very simple and quite efficient, provided it be instituted while the skin is still intact, and consists simply in placing over the affected area a small piece of mole-skin plaster, which should extend for a short distance out on the normal skin surrounding the blister; the same sort of plaster should here be used as was recommended for supporting sprained joints, and is an article so useful that it should be kept in every house. Where blisters have ruptured, the better plan is to apply some antiseptic, like tincture of iodine, and after having allowed it to dry, stick on some plaster as already directed. If no antiseptic be at hand the plaster should be used any way, but it should be frequently removed in order to see that no suppuration is occurring beneath. Small blisters, the result of burns, may be treated in a similar way with good results.

_Tooth-ache._--Tooth-ache is a condition for which there is no excuse in the present state of knowledge. As soon as decay begins in a tooth it should receive the attention of a competent dentist, and where this is done a true tooth-ache never occurs. Where one has been so neglectful as to permit the exposure of the nerve of a tooth, he can only be saved from much suffering by going at once to a dentist. In the meantime, various measures may be adopted to diminish the pain. A piece of cotton dipped in dilute carbolic acid and thrust into the cavity will almost immediately relieve the suffering for the time being. Oil of cloves, or a mixture of this substance with chloroform, applied in a similar way will bring about a like result. The reader cannot be too often reminded of the fact that bad teeth not only cause much suffering, but likewise lead to many digestive disturbances, and as a consequence little could be of more importance to the health of the body than to see to it that they be kept in perfect order. Where teeth are knocked out, they will often grow back and render good service for many years afterwards if replaced immediately in their sockets.

_Bites of Animals._--Wounds of this character, particularly those produced by dogs and cats, are not at all uncommon. Where it is definitely known that the animal is not rabid, the treatment should be that of punctured wounds,--to the chapter on which the reader is referred for further information.

Where there is reason to suspect that the animal has hydrophobia, it should be, if possible, at once confined, and watched for developments. Under no circumstances should it be killed. If the animal is rabid, it will be unable to eat or drink, and will die in the course of a few days; should it survive not the least fear need be felt as to it having had hydrophobia, as no instance is on record where the disease was followed by recovery. For further information on this subject, the reader is referred to the special article on hydrophobia (page 211).

_Hiccough._--Hiccough is a condition caused by a spasm of the diaphragm. All methods for the relief of this somewhat annoying condition are based upon the idea of having the patient hold his breath as long as is possible. The remedy is best applied by the sufferer holding his breath and leaning as far backward as is possible, and in the meanwhile distracting the attention by pointing the index finger of one hand towards the nose, and bringing the former toward the latter as slowly as is possible. Sticking the tongue out and holding the breath at the same time will often relieve hiccough, or if the victim can be induced to sneeze the distressing symptom will at once cease. The _slow_ swallowing of a few sips of water will frequently put an end to the trouble.