The Home Medical Library Volume I Part 2

_Rule 4.--Sprinkle with ice water from watering pot, or dash it out of basin with hand._

_Rule 5.--Dip sheet in ice water and tuck it snugly about patient._

_Rule 6.--Sprinkle outside of sheet with ice water; rub body, through the sheet, with piece of ice. Put piece of ice to nape of neck._

_Rule 7.--When temperature falls to 98.5 F. put to bed with ice cap on head._

=SUNSTROKE.=--There are two very distinct types of sunstroke: (1) Heat exhaustion or heat prostration. (2) Heat stroke.

Heat prostration or exhaustion occurs when persons weakened by overwork, worry, or poor food are exposed to severe heat combined with great physical exertion. It often attacks soldiers on the march, but also those not exposed to the direct rays of the sun, as workers in laundries, in boiler rooms, and in stoke-holes of steamers. The attack begins more often in the afternoon or evening, in the case of those exposed to out-of-door heat. Feelings of weakness, dizziness, and restlessness, accompanied by headache, are among the first symptoms.

The face is very pale, the skin is cool and moist, although the trouble often starts with sudden arrest of sweating. There is great prostration, with feeble, rapid pulse, frequent and shallow breathing, and lowered temperature, ranging often from 95 to 96 F. The patient usually retains consciousness, but rarely there is complete insensibility. The pernicious practice of permitting children at seaside resorts to wade about in cold water while their heads are bared to the burning sun is peculiarly adapted to favor heat prostration.

Heat stroke happens more frequently to persons working hard under the direct rays of the sun, especially laborers in large cities who are in the habit of drinking some form of alcohol. It often occurs in unventilated tenements on stifling nights. Dizziness, violent headache, seeing spots before the eyes, nausea, and attempts at vomiting, usher in the attack. Compare it with heat prostration, and note the marked differences. The patient becomes suddenly and completely insensible, and falls to the ground, the face is flushed, the breathing is noisy and difficult, the pulse is strong, and the thermometer placed in the bowel registers 107, 108, or 110 F., or rarely higher. The muscles are usually relaxed, but sometimes there are twitchings, or even convulsions. Death often occurs within twenty-four or thirty-six hours, preceded by failing pulse, deep unconsciousness, and rapid breathing, often labored or gasping, alternating with long intermissions. Sometimes delirium and unconsciousness last for days. Diminution of fever and returning consciousness herald recovery, but it is a very fatal disorder, statistics showing a death rate of from thirty to fifty per cent. Even when the patient lives, bad after effects are common. Peculiar sensibility to moderate heat is a frequent complaint. Loss of memory, weakened mental capacity, headache, irritability, fits, other mental disturbances, and impairment of sight and hearing are among the more usual sequels, occurring in those who do not subsequently avoid the direct rays of the sun, as well as an elevated temperature, and who indulge in alcoholic stimulants. A high degree of moisture in the air favors sunstrokes, but it is a curious fact that sunstroke is much more frequent in certain localities, and in special years than at other places and times with identical climatic conditions. This has led observers to suggest a germ origin of the disease, but this is extremely doubtful.

=Treatment.=--Treatment for heat exhaustion is given in the "first-aid" directions. Little need be added to the directions for treatment of heat stroke. In place of the ice cap suggested in Rule 7, ice in cloths, or in a sponge bag may be subst.i.tuted. The friction of the body, as directed in Rule 6, is absolutely necessary to stimulate the nervous system and circulation, and to prevent the blood from being driven into the internal organs by the cold applied externally.

The cold-water treatment is applied until the temperature falls down to within a few degrees of normal--that is, 98.6 F. Then the patient should be put into bed, there to remain, with ice to the head, until fully restored.

It often happens that the fever returns, in which event the whole process of applying cold water must be repeated. The simplest way of reducing the fever consists in laying the patient, entirely nude, on a canvas cot or wire mattress, binding ice to the back of his neck, and having an attendant stand on a chair near by and pour ice water upon the patient from a garden watering pot.

While the patient is insensible no attempt should be made to give anything by the mouth; but half a pint of milk and two raw eggs with a pinch of salt may be injected into the r.e.c.t.u.m every eight hours, after washing it out with cold water on each occasion. Two tablespoonfuls of whisky may be added to the injection, if the pulse is weak. If the urine is not pa.s.sed spontaneously, it will be necessary to draw it once in eight hours with a soft rubber catheter which has been boiled ten minutes and lubricated with glycerin or clean vaseline.

=ELECTRIC SHOCK OR LIGHTNING STROKE.=

_First Aid Rule 1.--Protect yourself from being shocked by the victim.

Grasp victim only by coat tails or dry clothes. Put rubber boots on your hands, or work through silk petticoat; or throw loop of rubber suspenders or of dry rope around him to pull him off wire, or pry him along with dry stick._

_Rule 2.--Do not lift, but drag victim away from wire toward the ground. When free from wire, hold him head downward for two minutes._

_Rule 3.--a.s.sist heart to regain its strength. Apply mustard plaster (mustard and water) to chest over heart; wrap in blanket wrung out of very hot water; give hypodermic of whisky, thirty minims._

_Rule 4.--Induce artificial respiration. Open his mouth and grasp tongue, pull it forward just beyond lips, and hold 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, Fig. 2). 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) all his 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 delicate person must be more gently handled.)_

_At the instant of letting go, the man at the patient's head 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 to 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 with hot-water bottles, hot bricks to limbs and feet, and blankets over exposed lower part of body._

_Rule 5.--Treat burn, if any. If skin is not broken, cover burn with cloths wet with Carron oil (equal parts of limewater and linseed or olive oil). If skin is broken, or raw surface is exposed, spread over it paste of equal parts of boric acid and vaseline, and bandage over all._

=Conditions, Etc.=--A shock produced by contact with an electric current is not of rare occurrence. Lightning stroke is very uncommon; statistics show that in the United States each year there is one death from this cause to each million of inhabitants. There are several conditions which must be borne in mind when considering the accidental effect of an electric current. The pressure and strength of the current (voltage and amperage) are often not nearly so important in regard to the effects on the body, as the area, duration, and location of the points of contact with the current, and the resistance offered by clothing and dry skin to the penetration of the electricity.

When the heart lies in the course of the circuit, the danger is greatest. A dog can be killed by a current of ten volts pressure when contacts are made to the head and hind legs, because the current then flows through the heart, while a current of eighty volts is required to kill a dog, under the same conditions, if contacts are made to head and fore leg. In a general way alternating currents of low frequency are the most injurious to the body, and any current pressure higher than two hundred volts is dangerous to life. On the other hand, a current of ninety-five volts has proved fatal to a human being. In this case the circ.u.mstances were particularly unfavorable to the victim, as he was standing on an iron tank in boots wet with an alkaline solution, and probably studded on the soles with nails, when he came in accidental contact with an industrial current. Moreover, he was an habitual drunkard. In an instance of the contrary sort, a man received a current of 1,700 volts (periodicity about 130) for fifty seconds, in one of the early attempts at electro-execution, without being killed. The personal equation evidently enters into the matter.

A strong physique here, as in other cases, is most favorable in resisting the effects of electric shock.

High-pressure alternating currents (1,300 to 2,000 volts) are employed in electro-executions, and the contacts are carefully made, so that the current will enter the brain and pa.s.s through the heart to the leg. The two most vital parts are thus affected. In industrial accidents such nice adjustments are fortunately almost impossible, and shocks received from high-pressure currents, even of 25,000 volts, have not proved fatal because both the voltage and amperage have been greatly lessened through poor contacts and great resistance of clothing and dry skin, and also because the heart is not usually included in the circuit.

Death is induced in one of three ways: 1. Currents of enormous voltage and amperage, as occur in lightning, actually destroy, burst and burn the tissues through which the stroke pa.s.ses. 2. Usually death follows accidents from industrial currents, owing to contraction of the heart, the effect being the same as observed on other muscles. The heart instantly ceases beating, and either remains absolutely quiet, or there is a fine quivering of some of its fibers, as seen on opening the chest in experiments upon animals. 3. A fatal issue may result from the pa.s.sage of the current through the head, so affecting the nerve centers that govern respiration that the breathing ceases.

=Symptoms.=--These are generally muscular contractions, faintness, and unconsciousness (sometimes convulsions, if the current pa.s.ses through the head), with failure of pulse and of breathing. For instance, a man who was removing a brush from a trolley car touched, with the other hand, a live rail. His muscles immediately contracted throwing him back, and disconnecting him from contact with the current (500 volts). He then fainted and became unconscious for a short time. The pulse was rapid and feeble, and the breathing also at first, but it later became slower than usual. On regaining sensibility the patient vomited and got on his feet, although feeling very weak for two hours.

Unconsciousness commonly lasts only a few moments in nonfatal cases, but may continue for hours, its continuance being rather a favorable sign of ultimate recovery, if the heart and lungs are acting sufficiently. Bad after effects are rare. It is not uncommon for the patient to declare that the accident had improved his general feelings. Occasionally there is temporary loss of muscular power, and a case has been reported of nervous symptoms following electric shock similar to those observed after any accidental violence. Burns of varying degrees of intensity occur at the point of entrance of the current, from slight blisters to complete destruction of all the tissues.

=Treatment.=--The treatment is completely outlined in the "first-aid"

directions. Should contact be unbroken, an order to shut off the electric current should at once be telephoned to the station.

Protection of the rescuer with thick rubber gloves is of course the ideal safeguard.

In fatal cases the heart is instantaneously arrested, and nothing can be done to start it into action. If the current pa.s.ses through the brain, by contact with the head or neck, then failure of breathing is more apt to be the cause of death. Theoretically, it is in the latter event only that treatment, i. e., artificial respiration, will be of avail.

But as in any individual case the exact condition is always a matter of doubt, _artificial respiration_ is the most valuable remedial measure we possess; it should always be practiced for hours in doubtful cases. Two tablespoonfuls of brandy or whisky in a cup of warm water may be injected into the bowel, if a hypodermic syringe is not available and the patient needs decided stimulation.

CHAPTER III

=Wounds, Sprains and Bruises=

_Treatment of Wounds--Rules for Checking Hemorrhage--Lockjaw--Bandages for Sprains--Synovitis--Bunions and Felons--Foreign Bodies in the Eye, Ear and Nose._

=WOUNDS.=--A wound is a condition produced by a forcible cutting, contusing, or tearing of the tissues of the body, and includes, in its larger sense, bruises, sprains, dislocations, and breaks or fractures of bones. As ordinarily used, a wound is an injury produced by forcible separation of the skin or mucous membrane, with more or less injury to the underlying parts.

_The main object during the care of wounds should be to avoid contamination with anything which is not surgically clean, from the beginning to the end of the dressing; otherwise, every other step in the whole process is rendered useless._

Three essentials in the treatment of wounds are:

1. The arrest of bleeding. 2. Absolute cleanliness. 3. Rest of the injured part. Dangerous bleeding demands immediate relief.

Bleeding is of three kinds: 1. From a large artery. 2. From a vein. 3.

General oozing.

=BLEEDING FROM LARGE ARTERY IN SPURTS OF BRIGHT BLOOD.=

_First Aid Rule 1.--Speed increases safety. Put patient down flat.

Make pressure with hands between the wound and the heart till surgeon arrives, a.s.sistants taking turns._

_Rule 2.--If arm or leg, tie rubber tubing or rubber suspenders tight about limb between wound and heart, or tie strap or rope over handkerchief or folded shirt wrapped about limb. If arm, put baseball in arm pit, and press arm against this. Or, for arm or leg, tie folded cloth in loose noose around limb, put cane or umbrella through noose and twist up the slack very tight, so as to compress the main artery with knot._

_Rule 3.--Keep limb and patient warm with hot-water bottles till surgeon arrives._

This treatment is of course only a temporary expedient, as it is essential for a surgeon to tie the bleeding vessel itself; therefore a medical man should be summoned with all dispatch.

=BLEEDING FROM VEIN; STEADY FLOW OF DARK BLOOD.=

_First Aid Rule 1.--Make firm pressure with pad of cloth directly over wound, also with hands between wound and extremity, that is, on side of cut away from the heart._