CHAPTER II.

EMERGENCIES, ACCIDENTS, SUDDEN SICKNESS.

The diseases last named were there mentioned because their distinctive character could be determined by the thermometer. They are, however, examples of the kind of cases that I design now to speak of particularly; where there is apparent cause for alarm, and where there is apparent necessity that something should be done immediately.

These cases demand the services of a physician, and my design is only to instruct you what to do before the doctor arrives; or rather I should say, the instructions that I give are not intended to supercede medical advice, though some cases may be of a kind in which little or nothing can be done. These emergencies are of every variety, and I shall bring the different kinds before you as fully as I can. Ordinarily it is not at first apparent what the real malady is.

We will suppose that during the heat of summer a man drops down unconscious. At first no one knows whether it is apoplexy or SUNSTROKE. Do not get excited and do things that are rash; if you do not know what ought to be done, do nothing; if you are not excited you may at least use what knowledge you have acquired.

Send a message to the doctor, giving a description as far as you can of the case, so that he may come prepared to treat it. Secure plenty of fresh air and room, and get rid of those who are around, who cannot be useful; if respiration is suspended, and there is immediate danger, something may be done at once; at least to know if the man has merely fainted. Have him laid in a horizontal position; you may soon have him carried to the nearest house. For this something should be provided on which he can lie horizontally; instruct the bearers to avoid unnecessary jolting; have a bed ready to put him on; if the case is supposed to be fainting give aromatic ammonia or a little stimulant of some kind; do not raise the head, but keep it low as the feet. If it is a severe case of sunstroke, the skin is hot and the pulse weak and fluttering; there may be convulsions, but probably there will be no movement; remove the clothing with as little disturbance as possible; do not cut anything that can be ripped; throw cold water on the head and chest, or put the patient in a cold bath of about 70° at first, and gradually reduce the degree of cold; give a cup of good table tea; do not give alcoholic stimulants without medical advice. If consciousness returns and the temperature again rises, repeat the cold applications to the head, neck, and chest; give ice water or ice tea; it may be best to rub the head and body an hour longer, and to give stimulant enemata.

APOPLEXY can be distinguished from syncope by the pulse, which beats perhaps with unnatural force; the face instead of being pale is generally flushed, and turgid, and the respiration goes on though it may be labored and stertorous. The condition of the sensorial functions is much the same as it is in narcotic poisoning, or when a man is dead drunk. The nurse should make all necessary enquiries so that she can furnish the physician with a full history of the case to help him in his diagnosis. In apoplexy the pulse is rather slow though full, and the pupils of the eyes, one or both, dilated. There may be paralysis of one side.

Loosen the clothes, elevate the head and chest, apply cold water to the head, and heat to the extremities, and perhaps sinapisms also. Giving physic may be deferred until the doctor arrives; and in general you may pursue a similar course whether the case is one of CONCUSSION OF THE BRAIN, or COMPRESSION or narcotic poisoning; cold may be applied to the head by means of pounded ice in a bladder; keep the head cool and the feet warm.

Many of this class of cases require still very careful nursing after the dangerous symptoms are relieved. The skin should be kept healthy by daily friction and bathing. The bowels must not be permitted to become costive; the diet should be light, the food well chewed, the mind kept cheerful and free from excitement.

POISONS.

In cases of poisoning no time is to be lost in administering relief, and it is important that the nurse should be familiar with all the usual antidotes.

Most commonly in a case of poisoning, speedy free vomiting should be induced by those articles that are at hand, and that are quick and prompt in their effects.

Even if the poison has been taken hypodermically, emetics may be given; these will do no harm: Sulphate of zinc (white vitriol), is very prompt in its action, and may be used when it can be procured (F. 134); and if vomiting be present, we may aid it by giving warm water, or perhaps pulv. ipecac, or some other vegetable emetic.

But either common salt or mustard is nearly always at hand and may be given. Stir up a tablespoonful of salt or a teaspoonful of mustard in a cup of warm water, and give immediately, and repeat until a pint is swallowed; do not stop to stir them very much, but give as quickly as possible. You may tickle the throat with a finger or a feather to induce immediate vomiting. Do not give tartar emetic; do not give fluids so as to distend the stomach too much; some bland fluid may be given with or immediately after giving mustard and salt; either milk, lime water, white of egg, flour and water, gruel, drinks sweetened with honey or sugar. Oil should not be given unless ordered.

Before naming the antidotes for particular poisons I wish to instruct the nurse to not only note the symptoms, but also to examine every article of a suspicious nature, (such as phials, boxes, or papers containing powders), and preserve them. Preserve also all vomited matter and everything that may afford a clue to the poison for after inspection, if the nature of the poison is likely to be a subject of after inquiry.

In regard to the symptoms it may be well to know that Prussic acid, cyanide of potassium, strong ammonia, pure carbonic acid gas, or pure carbonic oxide may KILL almost at once, as indeed almost every poison may if taken in a very large dose; strong acids, alkalies, aconite, antimony, arsenic, tobacco, or lobelia may cause SPEEDY COLLAPSE.

Belladonna, hyoscyamus, strammonium, canabis indica, alcohol or camphor, may cause DELIRIUM.

Nux vomica, strychnine, antimony, or arsenic may cause TETANUS or tonic contraction of the muscles.

Antimony, arsenic, carbonic oxide, aconite, strong acids or alkalies may cause CONVULSIONS.

Gelsemium, conium, aconite, arsenic, or lead may cause PARALYSIS.

Belladonna, atropine, hyoscyamus, or strammonium causes DRY SKIN; and opium, aconite, antimony, alcohol or lobelia causes MOIST SKIN. The skin is almost always moist in collapse.

Belladonna, atropine, hyoscyamus, stammonium, aconite, alcohol, chloroform or conium may cause DILATED PUPILS.

Opium or chloral may cause CONTRACTED PUPILS, especially during sleep.

Prussic acid, laudanum, alcohol, carbolic acid, acetic acid, ammonia, chloroform, creosote, iodine, phosphorus, camphor, or nitro benzole can often be smelled in the BREATH.

Belladonna, atropine, hyoscyamus, strammonium or opium cause the MOUTH and TONGUE to be DRY.

Arsenic, ammonia, cantharides, jaborandi or mercury cause SALIVATION.

Arsenic, antimony, corrosive sublimate, cantharides, digitalis, colchicum or colycinth causes VOMITING and PURGING.

Lead, colycinth, copper, or arsenic causes COLIC. Arsenic, antimony and lead cause CROUP.

ACIDS OF AN IRRITATING CHARACTER.

These include ACETIC, CITRIC, MURIATIC, NITRIC, OXALIC, SULPHURIC, and ARSENIOUS acids. Their irritating and corrosive character depend upon their strength and concentration, or the amount taken, some or all of them being salutary in small diluted doses. Their injurious effects are severe the moment they are swallowed, as they excoriate the throat and gullet at the time of swallowing. But antidotes will lessen their power on the stomach and bowels if given soon, and if given with the emetic will render the vomited matter less irritating. Their corrosive character causes severe pain, which may be followed by symptoms of shock.

Alkalies are the antidotes. Give some one that is at hand, either calcined magnesia, a solution of soda or soap, lime water or whiting. At the same time the emetics and alkalies are taken, give demulcents, such as milk, mucilage, gruel, flaxseed tea, etc. Of course the inflammation consequent on the poison must be treated.

Carbolic acid might be included among those above named; the same treatment would be proper, except that strong alkalies are ineffectual as antidotes. Besides emetics give milk, demulcent drinks, and carbonate of magnesia, with a little paregoric in water. Secure rest and warmth to the body, use counter irritants externally.

ARSENIOUS ACID is included in the above list. The antidote for this is hydrated peroxide of iron, recently prepared, and given in large doses. It is prepared by the addition of liq. ammonia to muriated tinct. of iron, or liq. ferri sulph., which yields the hydrated peroxide of iron as a dense precipitate; and this should be given in tablespoonful doses every five minutes until the symptoms are relieved. The nurse and attendant’s duty, however, is to give emetics and demulcents freely.

ALKALIES are like the acids, irritating; if strong they excoriate the fauces and esophagus. CAUSTIC POTASH, LYE, SODA AND HARTSHORN are examples. In these cases give acids such as vinegar and lemon juice as antidotes, and oils also to unite with the alkali and render it less irritating. Demulcent drinks must be given with the emetics, and acids must be continued afterwards.

For LUNAR CAUSTIC (nitrate of silver) give two teaspoonfuls of salt in a pint of water, also the white of egg with other demulcents.

CORROSIVE SUBLIMATE. For this poison the antidote is white of egg and milk, or a mixture of wheat flour and water and soap, which may be given with emetics, or after them; before if no emetic is at hand. The attendant nervous symptoms may be alleviated with paregoric.

TARTAR EMETIC of itself produces vomiting, but this may be kept up by giving mucilage and such astringent infusions as common tea, &c.

COPPER. The sulphate or acetate of copper might act as an emetic, but small quantities remaining in the stomach might act as irritant poisons. Give large doses of simple syrup as warm as can be swallowed; give also the whites of eggs and large quantities of milk; and as an antidote the hydrated peroxide of iron.

For BISMUTH, IODINE, or COPPERAS taken in an overdose, give the same emetics and demulcents as for copper.

ZINC and TIN. The sulphate of zinc and the salts of tin when not vomited entirely, produce severe irritating effects on the stomach. Besides milk and albumen give carbonate of soda in solution.

COLYCINTH, CROTON OIL, and SAVINE OIL may produce like the above, vomiting, diarrhœa, and also constriction of the throat. Give copious doses of barley water, etc.; give opium and perhaps stimulants. These cases and all the rest of the above may be benefitted by taking freely of gum Arabic mucilage, and may demand treatment for inflammation.

CANTHARIDES may produce severe pain in the bowels, bloody evacuations, strangury, burning thirst and fever. Give emollient drinks with enemata, to which some laudanum may be added, and also camphor; oil must not be given in cases of poisoning by cantharides or phosphorus.

TOADSTOOLS, AGARIC, ACONITE, BELLADONNA, CONIUM, COLCHICUM, HELLEBORE, and ALCOHOL, are acro-narcotics which may cause severe irritation of the throat and stomach, and such symptoms as burning heat of the esophagus and stomach, thirst, violent nausea, purging, dryness and constriction of the mouth and throat; and be followed by such symptoms as are produced by narcotic poisons: vertigo, headache, perversion of vision, sense of suffocation, disposition to sleep, numbness or paralysis of the limbs, prostration of the strength, cold extremities, feeble pulse, and stupor.

STRAMMONIUM, CAMPHOR, CHLORAL, DIGITALIS, BITTER-SWEET and HYOSCYAMUS may be called narcotic poisons. Give prompt emetics, demulcents, witch hazel, active purgatives, strong coffee; keep the patient roused, use electro-magnetism, cold douche, and employ friction.

For PHOSPHORUS, which a child sometimes obtains from the ends of matches, give emetics, and administer big doses of magnesia in water and mucilage. There are a few other poisons which might be classed as irritant, such as nitrate potash (salt petre) which need the same class of remedies as those already named. For nitre give also stimulants freely.

OPIUM and BELLADONNA are antidotes to each other, and if a person has taken an overdose of one, the other should be given if it is at hand. Evacuate the stomach perhaps by tickling the fauces; give also strong coffee, active stimulants, witch hazel; employ friction, perhaps electro magnetism, and keep the patient moving. Morphine of course demands the same.

For NUX VOMICA and STRYCHNINE, besides giving an emetic give aromatic spirits ammonia, and also chloroform internally in ½ drachm doses diluted. Give tannin and also animal charcoal, milk and spirits camphor in large doses.

CARBONATE and ACETATE of LEAD sometimes act as poisons. Give sulphate of zinc as an emetic, and epsom or glauber salts as a cathartic. A mixture of syrup and persulphuret of iron may be given as an antidote to any mineral poison.

HYDROCYANIC or PRUSSIC ACID, LAUREL WATER, and CYANIDE OF POTASH cause immediately extreme prostration, nausea, giddiness, pale countenance, slow breathing, and paralysis. Dash cold water on the face to produce a shock, taking care not to soak the clothes of the patient; we may produce a more decided effect if we alternate cold and hot effusions. Have the patient inhale steam containing liquor ammonia or hartshorn; give internally aromatic ammonia and chloroform; use friction, especially along the spine and feet; artificial respiration may be necessary. Give chlorine water of the strength of two drachms to the ounce.

ANIMAL POISONS. For BITES OF SERPENTS apply a ligature above the wounded part; use carbolic acid or any active caustic; apply cupping glass (or mouth, when there is no sore in the mouth). Bisulphite of soda in large doses is said to be an antidote. Give stimulants in large quantities.

MAD DOG BITES. A person having been bitten by a mad dog, or one suspected of rabies, the wound must first be made to bleed, then washed, and finally cauterized. Enlarge the wound so that the blood may flow out freely; press out still more blood, and you may safely suck out some if you do not have any sore on your mouth or lips. After tying a bandage above the wound it must be washed until cauterization can be effected. This can be made either with Vienna paste, butter of antimony, chloride of zinc, or a red hot iron. If the dog can be secured and shut up it is better than that he should be immediately killed. If the dog does not prove to be mad, the person bitten should know the fact, as this may prevent the alarming fears that of themselves sometimes prove disastrous. The bitten person should have his mind diverted as much as possible.

CARBONIC ACID GAS. A person having been poisoned by inhaling choke damp or the fumes of burning charcoal, loosen the clothing, dash cold water on the head and face, give plenty of fresh air, stimulants, and inhalations of ammonia. Employ artificial respiration if necessary. If the body is cold employ hot applications.

OTHER EMERGENCIES, PERSONS ASPHYXIATED FROM DROWNING, HANGING, &C.

When a person is asphyxiated treat him instantly. Give all the fresh air possible; remove all light clothing from the chest and neck and face; try to restore respiration first; clear the throat by placing the patient on the face with one arm under the forehead; the tongue falls forward and leaves the windpipe free; then wipe and cleanse the mouth.

TO EXCITE RESPIRATION turn the patient on his side and apply some stimulating agent (as camphor or ammonia) near the nostrils, and dash cold water, or hot and cold water alternately on the chest, which may have been previously rubbed briskly. (The effort to promote warmth and circulation by rubbing should be kept up continuously as far as possible.) Should there be no respiration immediately you can use

MARSHALL HALL’S METHOD to imitate respiration. “Turn the patient again on his face, raising and supporting the chest well on a folded coat or other article of dress; make gentle pressure on the back, after which turn him over on his side; then again on his face, and again press a little; repeat these motions at the rate of fifteen a minute. During the operation let one person attend to the movements of the head and the arm placed under it.” If there is respiration and consequent life, dry the hands, in cases of drowning; and as soon as you can, strip the body and gradually reclothe or cover it; but if the breathing is not satisfactory, after continuing these same efforts to restore respiration for about fifteen minutes, you may use

SYLVESTER’S METHOD. “Place the patient on the back on a flat surface, inclined a little upward from the feet; raise and support the shoulders and head on a cushion or a folded article of dress; draw forward the patient’s tongue, and keep it projecting beyond the lips, by having a band or string around the tongue and chin, or by raising the lower jaw so that the teeth retain it; standing at the patient’s head, grasp the arms near the elbows and draw them steadily upward above the head, and keep them stretched upwards for two seconds; then turn down the patient’s arms and press them gently and firmly against the chest for two seconds; repeat the movement alternately about fifteen times every minute until a spontaneous effort to inspire is perceived; then proceed TO INDUCE CIRCULATION AND WARMTH.” Rub the limbs upward with energy, and continue the friction under the blanket and over the dry clothing; promote the warmth of the body by applying flannels, bottles of hot water to the pit of the stomach, the armpit, the thighs, and the sole of the feet; then if the power of swallowing has returned, stimulants and coffee should be administered.

A STROKE OF LIGHTNING may cause immediate death by its effects on the nervous system. Sometimes it produces unconsciousness without being fatal. In attempting resuscitation employ artificial respiration, and if there are any signs of life treat as directed for shock. If there are burns complicating the case, of course the burns must be treated. When there is SHOCK the patient lies in an apoplectic state, the surface pale; there is faintness, trembling, cold perspiration, low temperature, feeble pulse, and probably nausea and vomiting. Keep the patient’s head low, give aromatic ammonia, and apply heat to the extremities and to the stomach. Strong beef tea should be given, and hot tea and coffee.

There are but few exigencies that generally occasion more alarm than CONVULSIONS. Fits may come on without premonitory symptoms; there is sudden loss of consciousness, accompanied by irregular and powerful contractions of the muscles. All the voluntary muscles may be affected, or there may be only spasm of the features, or of one side, or of a single limb. During a general paroxysm the countenance is distorted, and the face pallid or livid; generally there is stertorous breathing, and as the attack subsides a disposition to sleep. It is seldom fatal in adults, unless caused by brain or kidney disease.

Do not attempt too much treatment, but you may put the patient in such a condition as to help his recovery. His dress is to be loosened, and all clothing about his neck removed; place him where he can breathe pure and cool air, and you may prevent his falling out of bed; if the face is flushed, cold may be applied to the head and warmth and sinapisms to the extremities. If occurring in a young child you may give a warm bath, or a warm hip bath. If there is ability to swallow, give bromide of potassium, either alone or simultaneously with the administration of chloroform and ether.

GIVING ANESTHETICS.

If you give chloroform you may pour a few drops on a handkerchief and hold it an inch from the patient’s nose and lips. Ether and chloroform together may be poured, a teaspoonful at a time on a little cotton inside a cone of paper made large enough to fit over the mouth and nose, the air being nearly shut out. The head of the patient must be kept low while he is under the influence of it. Observe the pulse while giving it; a feeble pulse is a sign of danger, and if the pulse is growing weak, or the face is growing livid or pale, stop giving the chloroform; if the symptoms continue, and there is no natural respiration, draw the tongue forward so that it will not obstruct the trachea; have plenty of fresh air; apply friction by rubbing the limbs, and if necessary artificial respiration.

CLOTHES ON FIRE.

Accidents from fire are very likely to cause a panic, but possibly you may by effort so cultivate coolness and presence of mind, as to act wisely and deliberately even then, even if your own clothes are on fire. If you are able to think at all, the question will be if there is water within reach that can be used to extinguish it immediately; if there is not, how can it be smothered? Possibly the burning portion can be enveloped in that part of the dress that is not burned; or a rug may be within reach, or some woolen thing that may be used to stifle it, without pressing it against the person’s flesh. But very probably the best that the person can do is to lie down on the floor and roll on the carpet. If you see another woman on fire, do not scream or run away; grasp her clothes all together, if you can without pressing the fire against her person; or if you can immediately put out the fire by catching up a rug or some heavy woolen thing and enveloping her in it, do so. Remember at the same time to avoid inhaling much of the flames or setting fire to your own clothes.

BURNS AND SCALDS. There are various modes of treating burns, but one good general rule is that the dressings should be so applied as to exclude the air. If the skin is not destroyed or removed, either the bicarbonate of soda may be applied dry, or in a strong solution; or wheat flour may be applied dry, and the burn covered with a thick layer of cotton batting; or the white of egg may be spread over it, and another layer put on as soon as one dries, until some six or eight layers are applied. If the skin is abraded either olive oil or vaseline or carbolated cosmoline applied and covered with cotton or wool is a good dressing. (F. 187, 214.)

BURNS PRODUCED BY STRONG ACIDS should be first bathed with some alkaline solution such as soda or ammonia; on the contrary if lime or caustic potash cause the injury, neutralize the alkali by applying acid diluted; a teaspoonful of vinegar or lemon juice in a teacupful of water would suffice.

If a BAD SCALD is occasioned by a child falling backward in the water, carefully undress the child; lay it on a bed on its breast if the burn is on its back; then dust over the parts with bicarbonate of soda; lay muslin or cotton wool over it, and so arrange the bed by means of two boxes and a board that the covering cannot press on the scald.

If a FRAGMENT OF LIME GETS INTO THE EYE, bathe it immediately with a weak solution of vinegar or lemon juice.

If something like dust or dirt gets in the eye, it may be cleaned out by taking hold of the eye lash and pulling the upper lid down, and forcibly blowing the nose. You may sometimes wipe the dirt from the eye with a soft handkerchief. Always wipe the eye towards the nose.

When something like a PEA or CHERRY PIT IS IN THE NOSTRIL direct the patient to draw in a full breath, then close the mouth and the other nostril and try to blow the offending object out. If he fails you can probably remove it by means of a hair-pin; or while the other nostril is closed, blow forcibly into the mouth and dislodge the object.

Remove insects from the ear by oil or tepid water. A little oil or glycerine may first be dropped into the ear; and then it may be syringed with warm or tepid water, taking care not to close the opening with the nozzle of the syringe. This may be tried if the substance in the ear is hard.

If a child is choked let it get on all fours and cough. Anything stuck or lodged in the throat may sometimes be worked out with a hair-pin or bent wire.

If a CROCHET NEEDLE’S HOOKED POINT IS IN THE FLESH make certain on which side the hook is, then put an ivory bodkin or any similar article down to the hook, and draw both out together.

If a FINGER OR THUMB IS CUT in two, without any crushing of the parts, the severed portion should be immediately applied to its place; if the cut is clean, the hewn off part may be made to unite, possibly if it has been off for two hours. The wound should be washed with carbolic solution if that is immediately procurable, and the severed parts should be accurately fixed by sutures (stitches) in their normal position, and a splint applied.

Life is sometimes destroyed suddenly by persons drinking a large quantity of cold water when greatly fatigued. To avoid all danger in these cases, a small quantity should be sipped at a time; and washing the face, hands and temples before drinking is a good precaution. But if by drinking cold water the system is severely chilled so that prostration takes place, endeavor to secure warmth by giving a teaspoonful paregoric, and rubbing the hands and body briskly; and if the patient can be brought sufficiently to his senses he should be made to drink enough warm water to induce vomiting; this excites circulation and perspiration, and determines towards the surface. Warm applications should be made to the feet and to the region of the stomach, and the body should be warmed as soon as possible.