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° to 110° or even 112°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.