Chapter 20

Dr. Woodbridge, of New York, in a recent address, gave the following directions as to "What to do in case of a sudden wound when the surgeon is not at hand." "An experienced person would naturally close the lips of the wound as quickly as possible, and apply a bandage. If the wound is bleeding freely, but no artery is spouting blood, the first thing to be done is to wash it with water at an ordinary temperature. To every pint of water add either five grains of corrosive sublimate, or two and a half teaspoonfuls of carbolic acid. If the acid is used, add two tablespoonfuls of glycerine, to prevent its irritating the wound. If there is neither of these articles in the house, add four tablespoonfuls of borax to the water. Wash the wound, close it, and apply a compress of a folded square of cotton or linen. Wet it in the solution used for washing the wound and bandage quickly and firmly. If the bleeding is profuse, a sponge dipped in very hot water and wrung out in a dry cloth should be applied as quickly as possible. If this is not available, use ice, or cloths wrung out in ice water. If a large vein or artery is spouting, it must be stopped at once by compression. This may be done by a rubber tube wound around the arm tightly above the elbow or above the knee, where the pulse is felt to beat; or an improvised 'tourniquet' may be used. A hard apple or a stone is placed in a folded handkerchief, and rolled firmly in place. This bandage is applied so that the hard object rests on the point where the artery beats, and is then tied loosely around the arm. A stick is thrust through the loose bandage and turned till the flow of blood ceases."

BLEEDING FROM THE NOSE is rarely dangerous, and often beneficial. When it becomes necessary to stop it, sit upright and compress the nostrils between the thumb and forefinger, or with the thumb press upward upon the upper lip. A piece of ice, a snowball, or a compress wet with cold water may be applied to the back of the neck.

A SPRAIN [Footnote: "A sprain," says Dr. Hope, in that admirable little book entitled _Till the Doctor comes and How to help Him_, "is a very painful and very serious thing. When you consider that from the tips of the fingers to the wrist, or from the ends of the toes to the leg, there are not less than thirty separate bones, all tied together with straps, cords, and elastic bands, and about twenty hinges, all to be kept in good working order, you will not wonder at sprains being frequent and sometimes serious."] is often more painful and dangerous than a dislocation. Wrap the injured part in flannels wrung out of hot water, and cover with a dry bandage, or, better, with oiled silk. Liniments and stimulating applications are injurious in the first stages, but useful when the inflammation is subdued. _Do not let the limb hang down, keep the joint still_. Without attention to these points, no remedies are likely to be of much service. A sprained limb must be kept quiet, even after all pain has ceased. If used too soon, dangerous consequences may ensue. Many instances have been known in which, from premature use of an injured limb, the inflammation has been renewed and made chronic, the bones at the joint have become permanently diseased, and amputation has been necessitated.

DIARRHEA, CHOLERA MORBUS, ETC., are often caused by eating indigestible or tainted food, such as unripe or decaying fruit, or stale vegetables; or by drinking impure water or poisoned milk (see p. 321). Sometimes the disturbance may be traced to a checking of the perspiration; but more frequently to peculiar conditions of the atmosphere, especially in large cities. Such diseases are most prevalent in humid weather, when the days are hot and the nights cold and moist. Especial attention should at such times be paid to the diet. If an attack comes on, ascertain, if possible, its cause. You can thereby aid your physician, and, if the cause be removable, can protect the rest of the household. If the limbs are cold, take a hot bath, followed by a thorough rubbing. Then go to bed and lie quietly on the back. In ordinary cases, rest is better than medicine. If there be pain, have flannels wrung out of hot water applied to the abdomen. [Footnote: If it be difficult to manage the foments, lay a hot plate over the flannels and cover with some protection. By having a change of hot plates, the foments can be kept at a uniform high temperature. This plan will be found useful in all cases where foments are needed.] A mustard poultice will serve the same purpose if more convenient. Eat no fruit, vegetables, pastry, or pork. Use water sparingly. If much thirst exist, give small pieces of ice, or limited quantities of cold tea or toast water. Take particular pains with the diet for some days after the bowel irritation has ceased.

CROUP.--There are two kinds of croup--true and false. True croup comes on gradually, and is less likely to excite alarm than false croup, which comes on suddenly. True croup is attended with fever and false membrane in the throat; false croup is not attended with fever or false membrane. True croup is almost always fatal in four or five days; false croup recovers, but is liable to come on again. The great majority of cases of the so- called croup are simply cases of spasm of the glottis. "Croupy children" are those who are liable to these attacks of false croup, which are most frequent during the period of teething.--DR. GEO. M. BEARD. Croup occurs commonly in children between the ages of two and seven years. At this period, if a child has a hollow cough, with more or less fever, flushed face, red watery eyes, and especially _if it have a hoarse voice, and show signs of uneasiness about the throat_, send at once for a doctor. Induce mild vomiting by doses of syrup of ipecac. Put the feet in a hot mustard-and-water bath. Apply hot fomentations, rapidly renewed, to the chest and throat. A "croupy" child should be carefully shielded from all physical excitation, sudden waking from sleep, and any punishment that tends to awaken intense fear or terror. Irritation of the air passages through faulty swallowing in drinking hastily, should be guarded against. Good pure air, warm clothing, and a nourishing diet are indispensable.

COMMON SORE THROAT.--Wrap the neck in a wet bandage, and cover with flannel or a clean woolen stocking. Gargle the throat frequently with a solution of a teaspoonful of salt in a pint of water, or thirty grains of chlorate of potash in a wineglass of water.

FITS, APOPLEXY, EPILEPSY, ETC.--These call for immediate action and prompt medical attendance. Children who are teething, or troubled with intestinal worms, or from various causes, are sometimes suddenly seized with convulsions. Apply cloths wet in cold water--or, better still, ice wrapped in oiled silk--to the head, and _especially to the back of the neck_, taking care, however, that the ice or wet cloths do not remain too long. Apply mustard plasters to the stomach and legs. A full hot bath is excellent if the cold applications fail. Endeavor to induce vomiting. Seek to determine the cause, and consult with your physician for further guidance.

Apoplexy may be distinguished from a fainting fit by the red face, hot skin, and labored breathing; whereas, in a faint, the face and lips lose color, and the skin becomes cold. In many cases, death follows so quickly upon an apoplectic seizure, that little effectual service can be given. Call the nearest physician, loosen the clothing, and raise the head and shoulders, taking care not to bend the head forward on the neck. Keep the head cool. Do not move the patient unnecessarily.

In a common fainting fit, give the patient as much air as possible. Lay him flat upon the floor or ground, and keep the crowd away.

All that can be done in a fit of epilepsy is to prevent the patient from injuring himself; especially put something in his mouth to keep him from biting his tongue. A cork, a piece of India rubber, or even a tightly- rolled handkerchief, placed between the teeth will answer this purpose. Give the sufferer fresh air; loosen his clothing, and place him in a comfortable position. Epilepsy may be due to various causes,--improper diet, overexcitement, etc. Consult with a physician, and study to avoid the occasion.

CONCUSSION OF THE BRAIN generally arises from some contusion of the head, from violent blows, or from a shock received by the whole body in consequence of falling from a height. In any case of injury to the head where insensibility ensues, a doctor should be called at once. Remove the patient to a quiet room; loosen his clothing; strive to restore circulation by gentle friction, using the hand or a cloth for this purpose; apply cold water to the head, and, if the patient's body be cold and his skin clammy, put hot bottles at his feet. Ammonia may be cautiously held to the nose. Beyond this, it is not safe for a non- professional to go, in case of a severe injury to the head. Concussion is more or less serious, according to the injury which the brain has sustained; but even in slight cases, when a temporary dizziness appears to be the only result, careful treatment should be observed both at the time of the injury and afterward. Cases of head injury are often more grave in their consequences than in their immediate symptoms. Sometimes the patient appears to be getting better when really he is worse. Rest and quiet should be observed for several weeks after an accident which has in any way affected the brain.

TOOTHACHE AND EARACHE.--Insert in the hollow tooth cotton wet with laudanum, spirits of camphor, or chloroform. When the nerve is exposed, wet it with creosote or carbolic acid. Hot cloths or a hot brick wrapped in cloth and held to the face will often relieve the toothache. In a similar manner treat the ear, wetting the cloth in hot water, and letting the vapor pass into the ear.

CHOKING.--Ordinarily a smart blow between the shoulders, causing a compression of the chest and a sudden expulsion of the air from the lungs, will throw out the offending substance. If the person can swallow, and the object be small, give plenty of bread or potato, and water to wash it down. Press upon the tongue with a spoon, when, perhaps, you may see the object, and draw it out with your thumb and finger, or a blunt pair of scissors. If neither of these remedies avail, give an emetic of syrup of ipecac or mustard and warm water.

FROSTBITES are frequently so sudden that one is not aware when they occur. In Canada it is not uncommon for persons meeting in the street to say, "Mind, sir, your nose looks whitish." The blood cools and runs slowly, and the blood vessels become choked and swollen. _Keep from the heat_. Rub the part quickly with snow, if necessary for hours, till the natural color is restored. If one is benumbed with cold, take him into a cold room, remove the wet clothes, rub the body dry, cover with blankets, and give a little warm tea or other suitable drink. On recovering, let him be brought to a fire gradually. [Footnote: If you are caught in a snowstorm, look for a snow bank in the lee of a hill, or a wood out of the wind, or a hollow in the plain filled with snow. Scrape out a hole big enough to creep into, and the drifting snow will keep you warm. Men and animals have been preserved after days of such imprisonment. Remember that if you give way to sleep in the open field, you will never awake.]

FEVERS, and many acute diseases, are often preceded by a loss of appetite, headache, shivering, "pains in the bones," indisposition to work, etc. In such cases, sponge with tepid water, and rub the body till all aglow. Go to bed, place hot bricks to the feet, take nothing but a little gruel or beef tea, and drink moderately of warm, cream-of-tartar water. If you do not feel better the next morning, call a physician. If that be impossible, take a dose of castor oil or Epsom salts.

SUNSTROKE is a sudden prostration caused by intense heat. The same effect is produced by the burning rays of the sun and the fierce fire of a furnace. When a person falls under such circumstance, place your hand on his chest. If the skin be cool and moist, it is not a sunstroke; but if it be dry and "biting hot," there can be no mistake. Time is now precious. At once carry the sufferer to the nearest pump or hydrant, and dash cold water on the head and chest until consciousness is restored.--DR. H. C. WOOD.

To prevent sunstroke, wear a porous hat, and in the top of it place a wet handkerchief; also drink freely of water, not ice cold, to induce abundant perspiration.

ASPHYXIA, or apparent death, whether produced by drowning, suffocation, bad air, or coal gas, requires very similar treatment. Send immediately for blankets, dry clothing, and a physician. Treat upon the spot, if the weather be not too unfavorable.

1. Loosen the clothing about the neck and chest, separate the jaws, and place between them a cork or bit of wood.

2. Turn the patient on his face, place his arm under his forehead to raise the head, and press heavily with both hands upon the ribs to squeeze out the water.

3. Place the patient on his back, wipe out the mouth and nostrils, and secure the tongue from falling backward over the throat. Kneel at his head, grasp his arms firmly above the elbows, and pull them gently upward until they meet over the head, in order to draw air into the lungs; reverse this movement to expel the air. Repeat the process about fifteen times per minute. Alternate pressure upon the chest, and blowing air into the mouth through a quill or with a pair of bellows, may aid your efforts. Use snuff or smelling salts, or pass hartshorn under the nose. Do not lose hope quickly. Life has been restored after five hours of suspended animation. [Footnote: Another simple method of artificial respiration is described in the _British Medical Journal_. The body of the patient is laid on the back, with clothes loosened, and the mouth and nose wiped; two bystanders pass their right hands under the body at the level of the waist, and grasp each other's hand, then raise the body until the tips of the fingers and the toes of the subject alone touch the ground; count fifteen rapidly; then lower the body flat to the ground, and press the elbows to the side hard; count fifteen again; then raise the body again for the same length of time; and so on, alternately raising and lowering. The head, arms, and legs are to be allowed to dangle down freely when the body is raised.]

4. When respiration is established, wrap the patient in dry, warm clothes, and rub the limbs under the blankets or over the dry clothing energetically _toward the heart_. Apply heated flannels, bottles of hot water, etc., to the limbs, and mustard plasters [Footnote: The best mustard poultice is the paper plaster now sold by every druggist. It is always ready, and can be carried by a traveler. It has only to be dipped in water, and applied at once.] to the chest.

FOREIGN BODIES IN THE EAR.--Insects may be killed by dropping a little sweet oil into the ear. Beans peas, etc., may generally be removed by so holding the head that the affected ear will be toward the ground, and then _cautiously_ syringing tepid water into it from below. Do not use much force lest the tympanum be injured. If this fail, dry the ear, stick the end of a little linen swab into thick glue, let the patient lie on one side, put this into the ear until it touches the substance, keep it there three quarters of an hour while it hardens, and then draw them all out together. Be careful that the glue does not touch the skin at any point, and that you are at work upon the right ear. Children often deceive one as to the ear which is affected.

FOREIGN BODIES IN THE NOSE, such as beans, cherry pits, etc., may frequently be removed by closing the opposite nostril, and then blowing into the child's mouth forcibly. The air, unable to escape except through the affected nostril, will sweep the obstruction before it.

ANTIDOTES TO POISONS.

ACIDS: _Nitric_ (aqua fortis), _hydrochloric_ (muriatic), _sulphuric_ (oil of vitriol), _oxalic_, etc.--Drink a little water to weaken the acid, or, still better, take strong soapsuds. Stir some magnesia in water, and drink freely. If the magnesia be not at hand, use chalk, soda, lime, whiting, soap, or even knock a piece of plaster from the wall, and scraping off the white outside coat pound it fine, mix with milk or water, and drink at once. Follow with warm water, or flaxseed tea.

ALKALIES: _Potash, soda, lye, ammonia_ (hartshorn).--Drink weak vinegar or lemon juice. Follow with castor or linseed oil, or thick cream.

ANTIMONY: _Antimonial wine, tartar emetic_, etc.--Drink strong, green tea, and in the meantime chew the dry leaves. The direct antidote is a solution of nutgall or oak bark.

ARSENIC: _Cobalt, Scheele's green, fly powder, ratsbane_, etc.--Give _plenty of milk, whites of eggs_, or induce vomiting by mustard and warm water; [Footnote: See that the mustard is well mixed with the water, in the proportion of about half an ounce of the former to a pint of the latter.] or even soapsuds.

BITE OF A SNAKE OR A MAD DOG.--Tie a bandage above the wound, if on a limb. Wash the bite thoroughly, and, if possible, let the person suck it strongly. Rub some lunar caustic or potash in the wound, or heat the point of a small poker or a steel sharpener white hot, and press it into the bite for a moment. It will scarcely cause pain, and will be effectual in arresting the absorption of the poison, unless a vein has been struck.

COPPER: _Sulphate of copper_ (blue vitriol), _acetate of copper_ (verdigris).--Take whites of eggs or soda. Use milk freely.

LAUDANUM: _Opium, paregoric, soothing cordial, soothing syrup_, etc. --Give an emetic at once of syrup of ipecac, or mustard and warm water, etc. After vomiting, use strong coffee freely. _Keep the patient awake_ by pinching, pulling the hair, walking about, dashing water in the face, and any expedient possible.

LEAD: _White lead, acetate of lead_ (sugar of lead), _red lead_.--Give an emetic of syrup of ipecac, or mustard and warm water, or salt and water. Follow with a dose of Epsom salts.

MATCHES: _Phosphorus_.--Give magnesia, chalk, whiting, or even flour in water, and follow with mucilaginous drinks.

MERCURY: _Calomel, chloride of mercury_ (corrosive sublimate, bug poison), _red precipitate_.--Drink milk copiously. Take the whites of eggs, or stir flour in water, and use freely.

NITRATE OF SILVER (lunar caustic).--Give salt and water, and follow with castor oil.

NITRATE OF POTASH (saltpeter, niter).--Give mustard and warm water, or syrup of ipecac. Follow with flour and water, and cream or sweet oil.

PRUSSIC ACID (oil of bitter almonds), _cyanide of potassium_.--Take a teaspoonful of hartshorn in a pint of water. Apply smelling salts to the nose, and dash cold water in the face.

STING OF AN INSECT.--Apply a little hartshorn or spirits of camphor, or soda moistened with water, or a paste of clean earth and saliva.

SULPHATE OF IRON (green vitriol).--Give syrup of ipecac, or mustard and warm water, or any convenient emetic; then magnesia and water.

X.

SELECTED READINGS

TO ILLUSTRATE AND SUPPLEMENT THE TEXT.

_Arranged in order of the subjects to which they refer_.

"Read not to contradict and confute, nor to believe and take for granted, nor to find talk and discourse, but to weigh, and consider."

LORD BACON.

"He who learns the rules of wisdom without conforming to them in his life, is like a man who labored in his fields but did not sow."

SAADI.

SELECTED READINGS.

_The figures indicate the pages in the text upon which the corresponding subjects will be found_.

THE SKELETON.

MAN, AS COMPARED WITH OTHER VERTEBRATE ANIMALS (p. 3).--Man, the lord of the animal kingdom, is constructed after the same type as the cat that purrs at his feet, the ox that he eats, the horse that bears his burden, the bird that sings in his cage, the snake that crawls across his pathway, the toad that hides in his garden, and the fish that swims in his aquarium. All these are but modifications of one creative thought, showing how the Almighty Worker delights in repeating the same chord, with infinite variations. There are marked physical peculiarities, however, which distinguish man from the other mammals. Thus, the position of the spinal opening in the middle third of the base of the skull, thereby balancing the head and admitting an upright posture; the sigmoid S-curve of the vertebral column; the ability of opposing the well-developed thumb to the fingers; the shortened foot, the sole resting flat on the ground; the size and position of the great toe; the length of the arms, reaching halfway from the hip to the knees; the relatively great development of the brain; the freedom of the anterior extremities from use in locomotion, and the consequent erect and biped position. In addition, man is the only mammal that truly walks; that is endowed with the power of speech; and that is cosmopolitan, readily adapting himself to extremes of heat and cold, and making his home in all parts of the globe.--STEELE'S _Popular Zoology_.

FIG. 68.

UNION OF FRACTURES (p. 8).--In the course of a week after a fracture, there is a soft yet firm substance, something between ligament and cartilage in consistence, which surrounds the broken extremities of the bone, and adheres to it above and below. The neighboring muscles and tendons are closely attached to its surface, and the fractured extremities of the bone lie, as it were, loose in a cavity in the center, with a small quantity of vascular albumen, resembling a semitransparent jelly.

Here, then, is a kind of splint which nature contrives, and which is nearly completed within a week from the date of the accident. We call this new formation the _callus_. This process goes on, the surrounding substance becoming thicker and of still firmer consistence. In the course of a few days more, the thin jelly which lay in contact with the broken ends of the bone has disappeared, and its place is supplied by a callus continuous with that which formed the original capsule. This is the termination of the first stage of curative progress. The broken ends of the bones are now completely imbedded in a mass of vascular organized substance or callus, something between gristle and cartilage in consistence; and as yet there are no traces of bony matter in it. At this time, if you remove the adventitious substance, you will find the broken ends of bone retaining exactly their original figure and presenting the same appearance as immediately after the fracture took place.