The Home Medical Library Volume I Part 14

_Rule 2.--Remove poison from wound. Encourage bleeding by squeezing tissue about wound. Suck wound, if you have no cracks in lips, and spit out fluid. Pour hot carbolic solution into wound (a third of a teaspoonful of carbolic acid to a pint of hot water)._

_Rule 3.--Cauterize. Dip wooden meat skewer, or lead pencil, into pure nitric acid, and rub into wound. Or, use red-hot poker, or red-hot nail grasped by tongs or pincers, or red coal from fire._

_Rule 4.--Do not kill the animal. If he is alive and well at the end of a week, he was not mad._

CHAPTER IX

=Burns, Scalds, Frostbites, Etc.=

_Cla.s.ses of Burns--Treatment--Burns Caused by Acids and Alkalies--First Aid Rules for Frostbites--Real Freezing--Ingrowing Toe Nail--Fainting--Suffocation--Fits._

=BURNS AND SCALDS.=--If slight, skin very red, unbroken.

_First Aid Rule.--Cover with cloths wet in strong solution of baking soda in cold water. Dry gently, and spread with white of egg, thick._

If deeper, blisters, skin broken, thick swelling; there may be some bleeding.

_First Aid Rule 1.--Stop pain quickly. Cut away clothing very gently.

Break no blisters. Cover with Carron oil (equal parts of limewater and linseed or olive oil) and light bandage. Give fifteen drops of laudanum[9] every half hour in tablespoonful of water, till relieved in part or three doses are taken._

_Rule 2.--Combat shock. If patient is cold, pulse weak, head confused, give tablespoonful of whisky in a quarter of a gla.s.s of hot water. Put hot-water bottles at feet._

_Rule 3.--Quench thirst with pieces of ice held in mouth or a swallow of cold milk._

See page 174 for subsequent treatment.

A burn is produced by dry heat, a scald by moist heat; the effect and treatment of both are practically identical. Burns are commonly divided into three cla.s.ses, according to the amount of damage inflicted upon the body.

_First Cla.s.s._--There is redness, pain, and some swelling of the skin, followed, in a few days, by peeling of the surface layer (epidermis) and recovery. Sunburn and burns caused by slight exposures to gases and vapors fall into this category.

=Treatment.=--The immediate immersion of the part in cold water is followed by relief, or the application of cloths wet with a saturated solution of saleratus or baking powder is useful. Anything which protects the burned skin from the irritating effect of the air is efficacious, and in emergencies any one of the following may be applied: starch, flour, mola.s.ses, white paint, or a mixture of white of egg and sweet oil, equal parts. Usually after the first pain has been relieved by bathing with soda and water, or its application on cloths, the employment of a simple ointment suffices, as cold cream or vaseline.

_Second Cla.s.s._--In this cla.s.s of cases the inflammation is more severe and the deeper layers of the skin are involved. In addition to the redness and swelling of the skin there are present blisters which appear at once or within a few hours. The general condition is affected according to the size of the burn. If half of the body is only reddened, death usually results, and a burn of a third of the body is often fatal. The shock is so great at times that pain may not be at once intense. Shock is evidenced by general depression, with weakness, apathy, cold feet and hands, and failure of the pulse. If the patient rallies from this condition, then fever and pain become prominent. If steam has been inhaled, there may be sudden death from swelling of the interior of the throat, or inflammation of the lungs may follow inhalation of smoke and hot air.

_Third Cla.s.s._--In this cla.s.s are included burns of so severe a nature that destruction and death of the tissues follows; not only of the skin but of the flesh and bones in the worst cases. It is impossible to tell by the appearance of the skin what the extent of the destruction may be until the dead parts slough away after a week or ten days. The skin is of a uniform white color in some cases, or may be of a yellow, brown, gray, or black hue, and is comparatively insensitive at first. Pus ("matter") begins to form around the dead part in a few days, and the dead tissue comes away later, to be followed by a long course of suppuration, pain, excessive granulations ("proud flesh"), and, unless skillfully treated, by contraction of the surrounding area, leaving ugly scars and interfering with the appearance and usefulness of the parts. The treatment of such cases after the first care becomes that to be pursued in wounds generally (p. 50), and belongs within the domain of the surgeon.

=Treatment of the More Severe Burns.=--If the patient is suffering from shock he should receive some hot alcoholic drink, as hot water and whisky, and be put to bed under warm coverings with hot-water bags or bottles at his feet.

The clothing must be cut away from the burned parts with the greatest care, and only a portion of the body should be uncovered at a time and in a warm room. Pain may be subdued by laudanum[10]; fifteen drops may be given to an adult, and the drug may be repeated at hour intervals in doses of ten drops until the suffering has been allayed. Lumps of ice held in the mouth will quench thirst, and the diet should be liquid, as milk, soups, gruels, white of egg, and water. The bowels should be moved daily by rectal injections of soap and warm water. As a matter of local treatment, the surface layer of the skin should be kept intact if possible. Blisters are not to be disturbed unless they are large and tense; if so, their bases may be p.r.i.c.ked with a needle sufficiently to let out the fluid contents.

Carron oil (equal parts of olive oil and limewater) has been the common remedy for burns, and it is an efficient, though very dirty, dressing, useful if the skin is generally unbroken. It should be applied on clean, soft linen or cotton cloth, which is soaked in the oil, laid over the burned area, and covered with a thick layer of cotton batting and a bandage. When the skin is denuded, leaving a raw surface exposed, the burn must be treated on the same plan as wounds, and should be kept as clean and free from germs as possible. An ointment made of equal parts of boric acid and vaseline, spread thickly on clean cloth, is a good antiseptic preparation in cases where the skin is broken. It is best not to change the dressing oftener than once in two or three days, unless the discharge or odor are considerable. Fresh dressing is very painful and often harmful.

When the dressing is removed, warm saline solution (one teaspoonful of common salt in a quart of water) is allowed to flow over the burn until all discharge is washed off. Then the raw surface is dusted over with pure boric acid or aristol, and the boric-acid ointment applied as before. The cloth upon which the ointment is spread should be made free from germs by boiling in water, and then drying it in an oven and keeping it well wrapped in a clean towel except when wanted.

The same care is requisite as that described under wounds (p. 50) in regard to cleanliness.

Very extensive burns are most satisfactorily treated by complete immersion of the burned limbs or entire body in salt solution (same strength as above), which is kept at a temperature of from 94 to 104 F., according to the feelings of the patient. The patient lies in a bath tub on horsehair, or better, rubber mattress and rubber pillows; completely covered with water except the head. The urine and bowel discharges must be pa.s.sed in the water, which is then changed, and the temperature is kept at an even mark by allowing warm water to continually run into the tub to displace that which runs out. The latter can be arranged by siphonage with a rubber tube. While this method requires more care, and running hot and cold water, it is the most comfortable treatment for these cases, usually attended by awful suffering, and at the same time it is most favorable to healing.

It is beyond the scope of this work to describe the various complications and the details of the after treatment in severe burns, including skin grafting, which may tax all the ingenuity of the skilled surgeon. It is hoped that the foregoing may give a clear idea of the treatment to be pursued in emergencies and may prove of some use to those who may unfortunately be compelled to care for burns during a considerable time without the aid of a physician.

=BURN BY STRONG ACID.=

_First Aid Rule 1.--Neutralize the acid. Scatter baking soda thickly over burn, or pour limewater over it._

_Rule 2.--Control pain. Wash off soda with stream of water. Apply Carron oil (equal parts of limewater and linseed oil or olive oil).

Bandage lightly._

=BURN BY STRONG ALKALI.=--As ammonia, quicklime, lye.

_First Aid Rule 1.--Neutralize the alkali. Pour vinegar over the burn._

_Rule 2.--Control pain. Wash off vinegar with stream of water. Dry gently. Apply vaseline or cold cream._

=BURNS CAUSED BY STRONG MINERAL ACIDS OR BY ALKALIES.=--If acids are the cause, the skin should not be washed at first, but either chalk, whiting, or some mild alkali, as baking soda, should be strewn over the burn, and then after the effect of the acid is neutralized, wash off the soda with stream of warm water. Dry gently with gauze. Apply Carron oil or paste of boric acid and vaseline, equal parts. If strong alkalies have been spilled on the skin, as ammonia, potash, or quicklime, then vinegar is the proper substance to employ, followed by washing. Then dry gently. Vaseline or cold cream is usually sufficient as after treatment. Limewater is useful in counteracting the effect of acids spattered in the eye. In the case of alkalies in the eye, the vinegar used should be diluted with three parts of water. Albolene or liquid vaseline is the best agent to drop in the eye after either accident, in order to relieve the irritation and pain, and the patient should stay in a dark room.

=FROSTBITE, REAL FREEZING.=--Nose, ears, fingers, toes; insensible to touch, stiff, pale or blue. Person may be unconscious.

_First Aid Rule 1.--Restore circulation. Rub gently, then vigorously, with snow._

_Rule 2.--Restore heat very gradually. Sudden heat is fatal. Keep in cold room, and rub with cloth wet with very cold water till circulation is established. Then rub with equal parts of alcohol and water and expose gradually to heat of living room._

_Rule 3.--If person ceases to breathe, resuscitate as if drowned. Open his mouth, grasp his tongue, and pull it forward and keep it there.

Let another a.s.sistant grasp the arms just below the elbows and draw them steadily upward by the sides of the patient's head to the ground, the hands nearly meeting (which enlarges the capacity of the chest and induces inspiration.) (See pp. 30 and 31.) While this is being done, let a third a.s.sistant take position astride the patient's hips with his elbows resting on his own knees, his hands extended ready for action. Next, let the a.s.sistant standing at the head turn down the patient's arms to the sides of the body, the a.s.sistant holding the tongue changing hands if necessary to let the arms pa.s.s. Just before the patient's hands reach the ground the man astride the body will grasp the body with his hands, the ball of the thumb resting on either side of the pit of the stomach, the fingers falling into the grooves between the short ribs. Now, using his knees as a pivot, he will at the moment the patient's hands touch the ground throw (not too suddenly) his whole weight forward on his hands, and at the same time squeeze the waist between them, as if he wished to force something in the chest upward out of the mouth; he will deepen the pressure while he slowly counts one, two, three, four (about five seconds), then suddenly lets go with a final push, which will send him back to his first position. This completes expiration. (A child or a delicate person must be more gently handled.)_

_At the instant of letting go, the man at the head of the patient will again draw the arms steadily upward to the sides of the patient's head as before (the a.s.sistant holding the tongue again changing hands to let the arms pa.s.s, if necessary), holding them there while he slowly counts one, two, three, four (about five seconds)._

_Repeat these movements deliberately and perseveringly twelve or fifteen times in every minute--thus imitating the natural motions of breathing. Continue the artificial respiration from one to four hours, or until the patient breathes; and for a while after the appearance of returning life carefully aid the first short gasps until deepened into full breaths._

_Keep body warm after this with warm-water bottles._

=FROSTBITE.=--The nose, chin, ears, fingers, and toes are the parts usually frozen, although severe results ending in death of the frozen part occur more often owing to low vitality of the patient than to the cold itself. In the milder degree of frostbite there is stiffness, numbness, and tingling of the frozen member; the skin is of a pale, bluish hue and somewhat shrunken. Recovery ensues with burning pain, tingling, redness, swelling and peeling of the epidermis, as after slight burns. The skin is icy cold, white, and insensitive in severe forms of frostbite, and, if not skillfully treated, becomes, later, either swollen and discolored, or shriveled, dry, and black. In either case the frozen part dies and is separated from the living tissue after the establishment of a sharp line of inflammation which results in ulceration and formation of pus, and thus the dead part sloughs off. It is, however, possible for a part thoroughly frozen to regain its vitality.

=Treatment.=--The essential element in the treatment is to secure a very gradual return of blood to the frozen tissues, and so avoid violent inflammation. To obtain this result the patient should be cared for in a cold room, the frozen parts are rubbed gently with snow, or cloth wet with ice water, until they resume their usual warmth. Then it is well to rub them with a mixture of alcohol and water, equal parts, for a time and expose them to the usual temperature of a dwelling room. Warm drinks are now administered to the patient. The frozen member, if hand or foot, is raised high in the air on pillows and covered well with absorbent cotton and bandage.

If much redness, swelling, and pain result this dressing is removed and the part is wrapped in a single thickness of cotton cloth kept continually wet with alcohol and water.

Subsequent treatment consists in keeping the damaged parts covered with vaseline or cold cream, absorbent cotton, and bandage. If blisters and sores result, the care is similar to that described for like conditions under burns. If death of the frozen part becomes inevitable, the hand or foot should be suspended in a nearly vertical position to keep the blood out, and the part bathed twice daily with a solution of corrosive sublimate (one 7.7 gr. tablet to pint of water), dusted well with aristol, and dressed with absorbent cotton and bandage until the dead tissue separates and comes away. If the frozen part is large it may be necessary to remove it with a knife, but this is not essential when the tips of the fingers or toes are frozen.

=General Effect of Cold.=--Sudden exposure to severe cold causes sleep, stupor, and death. Persons found apparently frozen to death should be brought into a cold room, which should be gradually heated, and the body rubbed with snow or ice water, and artificial respiration employed, as just directed. Attempts at resuscitation ought to be persistent, as recoveries have been reported after several hours of unconsciousness and apparent death from freezing.