presented to the LIBRARY UNIVERSITY OF CALIFORNIA • SAN DIEGO by FRIENDS OF THE LIBRARY MRS. JOHN ALLEN COLE ^mJdi LIBRARY ; UNIVERSITY <^P 5 SAN x>itm J FirstAM to thelnjured Plain and simple rules to be followed in cases of accident or emergency as well as in the first stages of illness PKi 1 cvd e/l p K i dk. ^<^Pcni\ PublUKiivg CoiT\pc\i\y . ^_^___^ 1907 Copyright 1903 by The Penn Publishing Company Rrst Aid to the Injured. Table of Contents PAGE Introduction 5 CHAPTER I THE CONSTRUCTION OF THE HUMAN BODY Its Cells, Tissues, and Organs 7 CHAPTER II THE APPLICATION OF BANDAGES The Kinds of Bandages, their special uses, and the way to apply them 11 CHAPTER III HAEMORRHAGE AND ITS IMMEDIATE TREATiMENT Bleeding, external and internal, its Varieties, Symptoms, and Treatment ))y pressure, by Tourniquets, etc. ... 75 CHAPTER IV WOUNDS AND THEIR IMMEDIATE TREATiMENT Simple and poisoned Wounds ; Stings of Insects ; Snake and Dog Bites, and what to do for them 108 CHAPTER V SPRAINS, DISLOCATIONS, FRACTURES, ETC. The Causes. Signs, and Treatment of such Injuries ; how to apply Splints ; the Transportation of persons suffering witl- broken bones, etc 117 3 4 TABLi: OF CONTENTS CHAPTER Vr ARTIFICIAL RESPIRATION AND THE TREATMENT OF ASPHYXIA The various ways of promoting Artificial Breathing ; the Treatment of persons Apparently Drowned ; and of those suffering from Strangulation and Choking ... 157 CHAPTER VII POISONS AND THEIR IMMEDIATE TREATMENT How to tell whether Poison has been taken, and of what sort ; what to do in general if poison is suspected ; special Poisons and their treatment 172 CHAPTER VIII INSENSIBILITY AND FITS The causes and symptoms of Shock ; Brain injuries, Apo- plexy, Intoxication, Epileptic and other Fits, Hys- teria, and Convulsions of Infants 192 CHAPTER IX BURNS AND SCALDS How to treat them ; Shocks by Electricity ; Removal of ob- jects from the Eye, Ear, and Nose 207 CHAPTER X PREPARATION FOR A CASE OF ACCIDENT OR SUDDEN ILLNESS Preparation of Room, Bedstead, and Bed ; Specia. Bed for Fractures ; carrying the patient up-stairs ; lift:ng into bed, etc 215 INTRODUCTION The scope of First Aid is not to supersede medical or surgical treatment, but to render im- mediate temporary assistance to a person suffer- ing from an accident or sudden illness until the arrival of a doctor. The importance of First Aid will be apparent in such cases as — Haemorrhage from a wounded artery, Drowning, or a severe case of Fracture; in any one of the above it might make all the difference in saving the life or limb of a patient as to whether immediate treatment was rendered efficiently or improperly. First Aid should teach us how to render temporary assistance by improvised means for the relief of the patient, and the methods by which he can be removed to a place of safety. With these objects in view, the following pages contain, the Application of Bandages, the Tri- angular Bandage being described first, as this is most suitable for extemporized dressings ; then 5 6 INTRODUCTION comes the chapter on the Immediate Treatment of Haemorrhage, — from a First Aid point of view this is a subject of the greatest importance ; if proper help is not at hand a patient with a wounded artery might bleed to death in a few minutes. Then follow the chapters on the Im- mediate Treatment of Wounds, Dislocations and Fractures ; Asphyxia, Poisoning, Insensibility, Burns and Scalds, etc. ; and finall3% Preparation for the Keception of a case of Accident or Sud- den Illness. FIRST AID To The Injured and Sick CHAPTER I THE CONSTRUCTION OF THE HUMAN BODY The Cell — Its Structure and Properties — The Tissues — Kinds of and how formed — The Organs — How formed — Their different groups. The human body, like that of all animals, is built up of cells, which may be regarded as the primary or fundamental units of its construc- tion. The Structure and Properties of a Cell. — A cell is of microscopic dimensions, and in its simplest form, e. g., a white blood corpuscle, is seen to consist of two distinct parts, viz. : — (I) The Main Substance of the Cell. — This is 7 8 FIRST AID TO THE INJURED termed proto2)lmm^ and is a clear jelly-like mass ; - (II) The Kernel of the Cell. — This is termed tiie nucleus. It is generally placed near the centre of the cell and is denser in structure than the main substance. Some cells contain more than one nucleus. Cells vary in shape and size, the shape depend- ing upon the position and the functions they have to perform. Thus, cells may be round, long, oval, stellate, ciliated (furnished with hairs) or flaky. A cell possesses the power of reproducing itself by division, of moving about, of taking in nourishment and digesting it, and of excreting waste material. Every cell is therefore j)racti- cally a living organism. The Elementary or Simple Tissues of the body are formed by the aggregation of similar cells. They comprise the following : — 1. Epidermal or Epithelial Tissue (epidermis and the cellular lining of mucous membranes). 2. Connective Tissue (fat and tendon). 3. Cartilaginous Tissue (gristle). 4. Osseous Tissue (bone). 6. Muscular Tissue. m^ THE CONSrnUCTION OF THE HU3IAN BODY 9 6. Nervotis Tissue. 7. Blood. AVben several of the elementar}^ tissues are combined together they form The Compound Tissues, these comprise the fol- lowing : — 1. The Blood Vessels (which consist of con- nective, muscular and nervous tissue). 2. The Lymphatics (which consist of connec- tive and muscular tissue). 3. The Shin (which consists of connective, muscular, nervous and epidermal tissue). 4. The Seroios, Synovial and Mucous Mein- hranes (which consist of connective, epithelial, nervous, and muscular tissue). When several tissues combine together to form a special structure, having peculiar and definite functions, there is produced what is termed an organ. The Organs of the Body may be arranged into groups or systems according to their special functions, thus : — 1. The Organs of Locomotion ^\hQ'&^ comprise the bones and muscles. 2. The Organs of Circulation^ these comprise the heart and blood vessels. 10 FJEST AID TO THE INJURED 3. The Orga7is of J^espiration, these comprise the lungs and air passages. 4. The Orga7is of Digestion^ these comprise the mouth, gullet, stomach, and intestines. 5. The Organs of Secretion^ these comprise the liver, pancreas (sweet bread), salivary glands, and mucous glands. 6. The Organs of Excretion^ these comprise the skin and kidneys. 7. The Nervous Organs, these comprise the brain, spinal cord and nerves (including the organs of special sense, i. e., sight, hearing, smell, taste, and touch). 8. The Organs of Reproduction. CHAPTER II THE APPLICATION OF BANDAGES Uses of Bandages— Kinds of Bandages— The Triangular Band- age ; how to make it, how to fold it for storage, its advan- tages, w^ays in which it may be used, manner of folding it broad or narrow, the " reef " and "granny "knots, methods of applying the narrow, broad, and large arm slings — The Triangular Bandage for wounds of the scalp, forehead, back of head, temple, chin, ears, side of face, eye, neck, shoulder, chest, back, ribs (also for fracture of), abdomen, upper arm, elbow, forearm, wrist, hand, hip, thigh, knee, leg, foot, lower part of abdomen or perinaeum, groin — The Triangular Bandage for the stump of a limb, for fracture of the lower jaw, for securing splints, for arresting hsemor- rhage— The Roller Bandage ; its divisions, its sizes, how to roll it, its named parts, points to be remembered in its ap- plication, the manner in which it may be applied — The Circular Bandage— The Spiral Bandage— The Reverse Spiral Bandage— The Oblique Bandage— The Figure of 8 Bandage — The Spica Bandage — The Spica for the groin, the shoulder, the female breast, the thumb, the great toe, the heel, the elbow, the knee — To apply the roller bandage to the upper extremity, to the finger, to the lower extremity — The Head Bandages, viz., capeline and twisted -Bandage for the chest and the abdomen — Bandages of special form, viz. — 11 12 FIRST AID TO THE INJURED The Square Baudage — The Four-tailed Baudage for the jaw, head, aud knee— The Mauy-tailed Baudage aud the T Baudage. Bandages are employed for the following pur- poses : — (I) To give support to injured parts. (II) To keep dressings in place. (III) To fix splints and other apparatus. (IV) To overcome excessive muscular action. (V) To stop bleeding hy means of pressure. (YI) To protect wounded parts from exposure. The kinds of bandages in general use are : — (I) The Triangular Bandage. (II) The Koller Bandage. (Ill) Bandages of special form. I. THE TRIANGULAR BANDAGE AND ITS APPLICATION To make the Triangular Bandage. — Take a piece of linen or unbleached calico not less than thirty-eight inches square, fold it diagonall}^ and cut it along the fold. Each of the triangular pieces will then form one bandage. The named parts of the Triangular bandage are : The base of the triangle — this is termed the Lower Bor- der ; the two sides of the triangle — the Side THE APPLICATION OF BANDAGES 13 Borders; the apex of the triangle — the Point; the remaining corners of the triangle^the two ends. (Fig. 1.) POINT of €^ ^^ END/l-§ LN,END LOWER BORDER Fig. 1.— Triangular Bandage. To fold the Bandage for Storage. — First, spread the bandage out flat, then fold it perpendicularly down the centre, placing the right end on the left. Now bring the ends thus folded and the point to the centre of the lower border, forming a square ; then fold the square in half from right to left, next fold the two ends over or vice versa, making them meet in the centre ; now double again in half (this will give a packet 7^^xS}i") ,and secure with a pin. If folded over once more it forms a neat pad. (Fig. 2.) 14 FIRST AID TO THE INJURED :^c BC BC Fig. 2.— Method of folding triangular bandage for storage. The Triangular Bandage has the following ad- vantages : — It can be easily made from a hand- kerchief, and is therefore well suited as an emer- gency bandage ; its application can be easily acquired ; temporary dressings may be fixed better with it than with the Roller bandage, and it can be used for almost every purpose for which a bandage is required. THE APPLICATION OF BANDAGES 15 The Triangular Bandage may be applied : (I) Unfolded (called a '' whole cloth "). (II) Folded broad. (Ill) Folded narrow. To Fold the Bandage Broad or Narrow. — Spread the bandage out and carry the point 8 \ /\..^... L.7\ . .-s JL. 2:n. Fig. 3— Method of folding triangular bandage broad and narrow, lor use. IG FIRST AID TO THE INJURED (luvvii to the lower border. If required broad, fold it length ways upon itself once. If required narrow, fold it lengthways upon, itself twice. (Fig. 3.) To fasten the Bandage after applying it, either pin it with a safety pin or tie a reef or sailor's knot ; never tie a " granny " knot. To tie the Reef Knot proceed as follows : hold the ends of the bandage in the two hands ; wind the end held in the right hand over that held in the left ; then wind the end now held in the left over that held in the right, and bring it through the loop. The reef knot, if properly tied, should have its free ends l3'ing in the same line as the bandage. In the " granny " knot the ends lie at right angles to the bandage. The advantages of the reef knot over the " granny " are, that it is firmer, is less liable to slip, and it is easily untied. The use of the Triangular Bandac4e as a Sling For the Forearm The following slings may be applied with the Triangular bandage : — I. The Narrow Arm Sling. — This is applied by first folding the bandage narrow, then placing THE APPLICATION OF BANDAGES 17 one end over the shoulder of the uninjured side, and allowing the other end to hang down in front ; the forearm is now bent to the required height, the hanging end is drawn up in front of it and over the shoulder of the injured side and the two ends are then tied behind the neck. 2. The Broad Arm Sling. — This is made by folding the bandage broad, i. e., once on itself, and is applied in precisely the same way as the narrow arm sling. 3. The Large Arm Sling is applied in two ways : — (I) As a Support for the Forearm^ thus : — Place the apex of the bandage below and well beyond the elbow of the forearm on the injured side, and the upper end across the top of the op posite shoulder (Fig. 4) ; then carry the forearm across the chest to the desired level, now bring the lower end upward across the forearm, pass it over the shoulder of the injured side, and tie the two ends behind the neck ; then draw the apex forward over the point of the elbow and pin it to the bandage in front. (Fig. ^a.) (II) As a Support for the Elbow, thus : — Place the bandage with one end on the shoulder of the injured side and the apex pointing in the oppo- 18 FIRST AID TO THE INJURED S> Fig. 4. Fig. ia. Figs. 4. 4a.— The Large Arm Sling applied as a support lor the Forearm. site direction to the elbow ; then flex the fore- arm on the injured side, and place it across the front of the chest with the fingers touching the opposite shoulder (Fig. 5); now draw the lower THE APPLICATION OF BANDAGES 19 i:d over the elbow and across the front of the Iicst to the top of the shoulder on the uninjured side, and tie it to the upper end (Fig. 5«) ; then take the apex, fold it well over the forearm and 20 FIBST AID TO THE INJURED pin it to the bandage above on the injured side. (Fig. 6h.) A*- Fig. 5b. The Large Arm Sling applied as a support for the Elbow. The Triangular Bandage for Wounds Here before applying the triangular bandage, it is important in all cases to first apply to the wound clean (antiseptic) dressing, in the form of a pad. I. For a wound of the Scalp, first fold the THE APPLICATION OF BANDAGES 21 lower border of the bandage lengthways to form a hem 1^ inches wide, then place it with A Fig. 6. Fig. 6a. Fig. 6, 6a.— The triangular bandage for the Head. the middle of the hem over the centre of the forehead just above the root of the nose, and the point hanging over the back of the head to the neck ; now carry the two ends backward above the ears (which are left out), cross the ends be- hind at the nape of the neck over the point and below the occiput (the prominence at the back of the head) ; this is important, otherwise the band- age will not remain tight, bring the ends forward and tie them in front on the forehead (Fig. 6). 22 FIRST AID TO THE INJURED Next pull the point down, to make the bandage tit well over the head, then turn it over on to the top of the head and pin it. (Fig. Qa.) 2. For wounds of the Forehead or Back of the Head, fold the bandage narrow, place the centre of it over the pad on the wound, carry the ends horizontally round the head, cross them, and knot off over the dressing. 3. For a wound of the Temple, place the centre of the bandage folded narrow on the opposite temple to the one wounded, bring the ends for- ward, cross them over the pad placed on the wound (Fig. Y), then carry them respectively over the top of the head and below the jaw, and tie on the sound temple exactly opposite the crossed ends. (Fig. 7^.) 4. For wounds of the Chin, Ears, or Side of the Face, place the centre of the bandage folded narrow under the chin, carry the ends upward and tie on the top of the head. 5. For wounds of both Eyes, place the centre of the bandage folded narrow on the bridge of the nose, carry the ends backw^ard, cross them, bring them forward and tie in front. 6. For a wound of one Eye, place the centre of the bandage folded narrow over the injured THE APPLICATTON OF BANDAGES 23 eye, pass the ends obliquely, one upward over the forehead and the other downward over the J^9- 7. ITig. 7a. Figs. 7, 7a.— The triangular bandage for the Temple. Fig. 8.— The triangular bandage for the Eye. ear, cross them behind, and below the occiput. 24 FIBST AID TO IHE INJURED then bring them forward and tie over the pad on the wound. (Fig. 8.) 7. For a wound of the Neck, place the centre of the bandage folded broad or narrow (accord- ing to the size of the wound), on the pad, carry the ends round the neck, cross them, bring them back and tie over the pad. 8. For a wound of the Shoulder, place the centre of the bandage un- folded on the point of the shoulder, with the point of the bandage well up to the angle of the jaw, and the lower border across the middle of the upper arm, then carry the ends round the arm, cross them on the inner side, bring them for- ward and tie on the outside; now place the forearm on the injured side in a narrow arm sling, then pass the point of the bandage under Fig. 9.-The triangular bandage^he sling, doublc it back OU - for the Shoulder. -^g^^^^ ^^^ p-^^ |^ ^^ ^^IQ bandage on the top of the shoulder. (Fig. 9.) THE APPLICATION OF BANDAGES 25 N'ote. — Should the shoulder be injured so as not to be able to bear the weight of the forearm in a sling, after applying the first bandage to the wound, take a second bandage folded narrow, place the centre of it over the point of the first bandage, carry the ends obliquely down- ward and tie them under the armpit on the sound side, then double the point back on itself and pin it to the bandage on the top of the shoulder. 9. For wounds of the Front of Chest, apply the bandage unfolded, with its centre across the front of the chest and its point over the shoulder on the injured side (Fig. 10) ; carry the two ends round the chest and tie them at the back, leaving one end longer than the other; now draw the point well over the shoulder and tie it to the longer end behind. (Fig. 10a.) 10. For wounds of the Back, apply the band- age in a reverse way to the above. 11. For a wound of the Side of the Chest, take a bandage folded broad, apply the centre of it over the pad on the wound, carry the ends round the chest and tie on the opposite side. Wote. — In applying this bandage it should be tied just tight enough to retain the pad in position, 26 FIRST AID TO THE INJURED but it should not compress the chest wall un- duly. Fig. 10. Fig. 10a. Figs. 10, 10a.— The triangular bandage for the Chest. 12. For a wound of the Abdomen, apply the centre of the bandage folded broad over the pad on the wound, and tie the ends at the side. 13. For a wound of the Upper Arm, apply the middle of the bandage folded narrow over the pad on the wound, carry the ends backward, THE APPLICATION OF BANDAGES 27 cross them behind, bring them forward and tie in front; then place the forearm on the injured side in a narrow arm sling. 14. For a wound of the Elbow, a bandage may be applied in two ways: — (J) Flex the elbow ; then, after turning in a broad hem on the lower border of the bandage, place tlie centre of it over the point of the elbow with the point of the bandage upward, pass the ends round the forearm, cross them in front, carry them round the arm again, cross them be- hind above the joint, bring them forward and tie in front (Fig. 11) ; then draw the point well down and pin it to the bandage below (Fig. 11a). Now place the arm in a narrow arm sling. (II) Flex the elbow, then place the centre of the bandage folded broad over the point of the elbow, bring the ends forward, cross them in front, carry them backwards round the upper part of the forearm, cross them behind and below the point of the elbow securing the lower q(\^q of the broad bandage, then bring them forward, again cross them in front, now carry them back- ward round the lower part of the upper arm, securing the upper edge of the broad bandage, and tie behind just above the point of the elbow 28 FIRST AID TO THE INJURED (Fig. lih). Then place the forearm in a narrow arm sling. 15. For wounds of the Forearm, or of the Wrist, apply the bandage folded narrow in the Fig. 11. Fig. 11a. Fig. \\b. Figs. 11, 11a, 11&.— The triangular bandage for the Elbow. same manner as for the upper arm, and then place the forearm in a large arm sling. 16. For a wound of the Hand. (I) To cover the Whole Hand. — Spread out a bandage unfolded, place the hand upon it with THE APPLICATION OF BANDAGES 29 the wrist on the centre of the lower border — palm downward and the fingers toward the point (Fig. 12) — turn the point over the fingers Fig. 12a. 30 FIliST AID TO THE INJURED and carry it across to the back of the wrist, then draw the bandage downward on each side of the hand (Fig. l'2a\ and pass the ends upward Fig. 12&. Fig. 12c. Figs. 12, 12a, 126, 12c.— The triangular bandage for the Whole Hand. round the back of the wrist, cross thein over the point (Fig. l^h) ; then carry them in front of the wrist, bring them back again and tie them over the point (Fig. 126^) ; now draw the point over the knot and pin it to the bandage below. (II) To cover the Pahn or the Back of the Hand. For the Pahn. — Place the centre of the band- age folded narrow over the pad on the wound, bring the ends round the hand, cross them on the back obliquely ; then bring them over the wrist THE APPLICATION OF BANDAGES 31 forward, cross them in front, carry them bad .igain over the wrist, and tie. (Fig. 13.) Pig 13.— The triangular bandage for the Paliu of the Hand Fig. U.— The triangular bandage for the Fist I^or the Back. — Reverse the process. (Ill) I^or a wound iti the Palm of the Hand, either of the following methods may be used : — {a) Place a firm pad in the palm to well fill it, and bend the fingers over the pad, now apply the centre of the bandao:e folded broad lontrjtu- dinally across the bent fingers, carry the ends up toward the wrist, cross them just below the root of the thumb, then take them round the wrist and cross them on the opposite side, bring the 32 FIRST AID TO THE INJURED lower end forward and carry it over the first knuckle of the index finger to the back of the wrist, now carry the upper end from within out- ward once or twice round the wrist and then tie the two ends together. (Fig. 14.) (b) Squire's Method. — After placing a firm pad in the palm of the hand and bending the fingers over it, apply the centre of the bandage folded broad across the back of the wrist ; now carry the thumb end of the bandage diagonally across the front of the hand over the knuckles, and across the back of the hand to the thumb side of the wrist again ; then carry the other end diagonally across in the opposite direction ; now bring both ends round to the front of the wrist, cross them, pull tight, carry them round to the back of the wrist, and tie. {c) Spread out a bandage unfolded, turn up a fairly broad hem on the lower border, then place the closed fist with a firm pad in it on the cen- tre of the bandage — back of the hand down- ward — bring the point over the fist to halfway up the forearm, carry the ends forward, cross them in front on the wrist, then carry them backward and cross them on the back of the wrist, again bring them forward and tie in front. THE APPLICATION OF BANDAGES o*, now draw the point firmly down over the knot and pin it to the bandage below. After the hand has been bandaged by any of the above methods, the elbow should be sup- ported in the large arm sling. 17. For a wound of the Hip, first tie one band- age folded narrow, like a waist belt, round the Fig. 15.— The tiiangular bandage for the Hip. 34 FIRST AID TO THE INJURED body just above the hips ; then apply the centre of a second bandage unfolded on the wounded hip, with the lower border well down on the thigh, carry the ends backward round the thigh, cross them behind, bring them forward, and tie them on the outside ; now pass the point under the narrow bandage, bring it down and pin it to the bandage below. (Fig. 15.) \^^ V y/ Fig. 16— The triangular bandage for the Foot. TBE APPLICATION OF BANDAGES 35 8. For a wound of the Thigh, Knee, or Leg, apply the bandage folded broad, in the same manner as for the upper arm. In applying the bandage to the knee, the leg should be kept straight and the knot should be tied below the knee-cap. 9. For a wound of the Foot, spread out a bandage unfolded, place the foot on the centre of it with the toes toward the point, draw the point upward over the instep ; take one of the ends in each hand close up to the foot, bring them forward round the ankle to the front and over the point, cross them on the instep, carry tJie ends back round the ankle, cross them be- hind, catching the lower border of the bandage, bring them forward again and tie in front on the ankle; now draw the point well over the knot and pin it to the bandage below. (Fig. 16.) 20. For a wound of the Lower Part of the Abdomen or of the Perinseum, the bandage may be applied in two ways : — (I) Apply the bandage unfolded with its lower border uppermost and the centre of the bandage well over the front of the lower part of the ab- domen ; pass the two ends backward and tie 3G FIRST AID TO THE INJURED them behind ; draw the point down to tighten the bandage ; then carry it between the legs, draw it up well behind and tie it to the ends. (Fig. 17.) Fig. 17 —The triangular bandage for the lower part of the Ab- domen. Fig. 18.- The iriiiugiilar bandage for the Groin. (II) Tie one bandage folded narrow just above the hips, like a waist belt ; take another band- THE APPLICATION OF BANDAGES 37 age also folded narrow, pass one end beneath the waist bandage at the centre of the back, fold it over and pin it, then bring the other end for- ward between the thighs, pass it under the waist bandage in front, fold it over and pin it. 21. For a wound in the Groin, tie two band- ages folded narrow end to end ; apply the centre of this double bandage to the back of the thigh, just below the buttock, bring the ends forward, cross them over the pad on the wound in the groin, carry them back above the hips, and tie in front. (Fig. 18.) 22. For the Stump of a Limb, lay the bandage unfolded below the stump with the lower border upward, draw the point well over the stump ; bring the ends forward, cross them over the point, carry them back, again cross them, bring them forward and tie in front ; now draw the point forward well over the knot and pin it to the bandage below. (Fig. 19.) The Triangular Bandage for Fractures The Triangular bandage may be used I. For putting up the following Fractures : — (I) Fracture of the Jaw. (II) Fracture of the Ribs. 38 FIRST AID TO THE INJURED (III) Fracture of the Clavicle. (lY) Fracture of the Pelvis. {See Chapter Y, Fractures.) Fig. 19.— The triangular bandage for a Stump 2. For fixing Splints to Limbs. — If it is re- quired to secure splints to the arm, forearm, wrist, leg or ankle, the bandage should be used folded narrow ; if splints are to be tied to the thigh or knee, the bandage should be folded THE APPLICATION OF BANDAGES 39 broad. Either of the following methods may be adopted : — (I) First adjust the splints to the limb, now raise and steady the limb ; then place the centre of the bandage folded either narrow or broad, as the case may be, over the outer splint at the spot where it is to be tied, pass the two ends round the limb, cross them on the inside, bring them forward and tie on the outside over the centre of the splint. (II) By the Looped Triangular handage, which is applied as follows : Take a triangular bandage folded narrow or broad, double it length- ways upon itself ; then, after adjustmg the splints to the limb, raise and steady it, and place the loop from above upon the outer splint at the spot where the splints are to be tied, carry the ends round the limb from without inward, then pass both ends through the loop, one from right to left and the other in the opposite direction ; now tighten the bandage by steadily drawing on the two ends, and then tie over the centre of the splint. The advantage of this method is that splints can be easily fixed without unduly dis- turbing the parts. Wote. — Always fix splints to the limb first above the seat of fracture. 40 first aid to the injured The Triangular Bandage to Arrest Hem- orrhage Here the Triangular bandage may be used : — 1. To Improvise a Tourniquet. 2. To Bandage the Limbs to each other in the Method of Forced Flexion. (For these, see chapter XI, Hgemorrhage.) 3. As a Knotted or Twisted Bandage. This method of apphcatiun is described above (see Wound of Temple, page 22). 4. For Venous Haemorrhage. To tie round a lim b. Catitio7i. — After bandaging for haemorrhage, do not in the absence of the surgeon Leave a tight bandage on for more than three hours. II. THE ROLLER BANDAGE AND ITS APPLICATION The Eoller Bandage is essentially the bandage for use in all cases where it is required to main- tain firm pressure, e. g., to control bleeding, to fix dressings after operations, etc. For emer- gency cases in non-professional hands the Koller is not so well adapted as the Triangular, as it re- THE APPLICATION OF BANDAGES 41 quires for its proper application considerable skill and experience. KoLLER Bandages May Be Divided Into — 1. Elastic Bandages.—These are of several kinds, woven, India rubber, etc ; they are used to check the flow of blood when drawn tightly round a part and to give support, as in varicose veins. 2. Semi-elastic Bandages. — These are made out of flannel, domette, silk, cotton, net, etc. As they lie more smoothly, they are easy to apply and do not want reversing. 3. Non-elastic Bandages. — These are made out of gray sheeting, unbleached or bleached calico, linen, etc., and are the roller bandages in general use The Sizes of the Roller Bandages for Adults are as Follows : Part Breadth Length 'the Head - 2 to 2i ins. 5 to 7 yards " Finger - fin. - 1 to 2 " " Hand - - lin. •• 4 to 5 " " Arm _ H to 2^ ins. - 8 to 12 " " Shoulder - 2| to 3 ins. - 8 to 12 " " Chest or Abdomen 3 to 4 ins. - 6 to 8 " " Leg or Thigh - 2i to 3 ins. - 10 to 12 " " Foot - 2^ ins. 4 " 42 FIRST AID TO THE INJURED To Roll the Bandage. — Turn in enough of one end to start the roll, place the bandage upon the thigh with the part rolled near the groili, and roll the cylinder with the palm of the hand upon it from above downward. When the roll is completed insert a couple of pins in it. The Named Parts of the Bandage Are : — The initial or free end ; the rolled up or terminal end ; and the body. When a bandage is rolled up from one end only it is termed a single-roller, when rolled up from both ends a double roller. Points to be Observed in the Application of the koller bandage (I) Before applying the bandage see that it is tightly rolled. (II) Stand in front of the limb to be band^ aged, and place it in the exact position in which it is to be kept, if it is the upper limb bend the elbow, and place the hand with the thumb point- ing upward. (III) Commence by applying the outside of the bandage to the inside of the limb and then taking a couple of turns round the limb to fix the bandage. THE APPLICATION OF BANDAGES 43 (IV) Always bandage from below upward, ex- cept when otherwise indicated. (Y) Always bandage from within outward, over the front of a limb. (YI) While bandaging, never unroll more than two or three inches of the bandage at a time. (YII) Let each succeeding turn of the bandage overlap two-thirds of the preceding turn. (YIII) Bandage the part firmly but never too tightly, or too loosely ; if the edges turn up on running the hand down a bandage after it has been applied, is shows that the bandage is too loose. (IX) Use firm, equable pressure throughout the bandage ; if when the bandage is removed red lines are seen on the surface of the skin, it in- dicates that unequal pressure has been exerted by the bandage. (X) In bandaging a limb, leave the tips of the fingers and of the toes uncovered, in order to see that the bandage has not been applied too tightly ; if the tips become blue and cold loosen the bandage. (XI) Apply the bandage smoothly, leaving no wrinkles. (XII) Keep all the margins parallel, and keep 44 FIRST AW 10 THE INJURED the crossings and reverses in one line, and toward the outer side of the limb. (XIII) Never reverse the bandage over a sharp bone. (XIV) Always form a figure of 8 over a joint, (XY) Never apply a bandage wet ; when dry it will shrink and bind the limb too tightly. (XVI) End by fixing the bandage securely with a safety pin. (XYII) Never re-apply a bandage without first completely winding it up. (XVI II) In taking off a bandage gather the slack into a loose bundle, and pass it round and round the part from which it is being removed. The Roller Bandage May be Applied in THE Following Ways: (I) As a Circular bandage. (II) As a Simple Spiral bandage. (III) As a Reversed Spiral bandage. (IV) As an Oblique bandage. (V) As a figure of 8 bandage and its modifi- cation the Spica. I. The Circular Bandage consists of a series of turns made round a part, each turn exactly overlapping the one preceding it. THE APPLICATION OF BANDAGES 45 2. The Simple Spiral Bandage consists of a series of spiral turns, each turn overlapping the preceding one by about two-thirds. It can only be applied to those parts which vary but slightly Fig. 20.— The Simple Spiral. Fig. 21.— The Reverse Spiral. in their circumference, such as the forearm just above the wrist, and the fingers. (Fig. 20.) 3. The Reverse Spiral Bandage consists of a series of spiral turns in which the bandage is re- versed upon itself while it is being applied, the object of reversing being to make the bandage lie smoothly and firmly over parts which vary 46 FIEST AID TO THE INJURED considerably in diameter — such as the upper part of the forearm, the calf, etc. To Reverse jproceed as follows : First take a couple of spiral turns round the limb, then hold- ing the head of the bandage lightly in one hand, place the thumb of the disengaged hand over the lower border of the bandage, on the outer side of the limb ; now slacken about three inches of the bandage, turn it over, reverse it downward, pass it under the limb to the opposite side, keep- ing its lower edge parallel with that of the turn be- low ; when the outer side of the limb is reached make the reverse again, and so on. (Fig. 21.) This bandage is firmer than the simple spiral and is to be preferred for fixing splints to a limb. Its disadvantages are that it is somewhat liable to slip, and it is not elastic. 4. The Oblique Bandage consists of a series of rapidly ascending spirals which pass up the limb without their edges overlapping. It is used only for holding dressings loosely in place. 5. The Figure of 8 Bandage consists of a series of loops, each loop forming a figure of 8, and overlapping the one below by about two-thirds the width of the bandage. To Ajp]^ly the figure of 8 Bandage to a part, THE APPLICATION OF BANDAGES 47 6.^., the back of the hand, proceed as follows: Take a couple of turns round the wrist to fix the bandage, then carry the bandage from the thumb side of the wrist across the back of the hand to the base of the little finger, then across the palm at the root of the fingers, then obliquely across the back of the hand to the outer side of the wrist, then across the palm at the root of the fingers and again obliquely over the back of the hand toward the root of the little finger, leaving about one-third of the first loop uncovered, then again across the palm and over the back of the hand to the wrist. Eepeat these turns about three times, taking care that the loops overlap each other by about one-third the width of the bandage, and finally fix the bandage with a circular turn round the wrist. (Fig. 22.) Fig. 22.— The Figure of 8. The figure of 8 bandage is employed chiefly in the neighborhood of joints; it is less firm but 48 FIEST AID TO THE INJURED jiiuic elastic than the reverse spiral band- age. The Sjjica Bandage. — This is a modification of the Figure of 8 bandage, having one loop much larger than the other. It is used to retain dress- ings, and to keep up pressure on a joint. There are two methods of applying the Spica, viz. : — (i) The Ordinary Spica which is used at the junction of a limb. (ii) The Divergent Spica, which is used to cover in large prominences, such as the heel, the bend of the knee, and the elbow. The Spica Bandage for the Groin may be em- ployed either from below upward as an " ascend- ing spica," or from above downward as a "de- scending spica." (I) The Ascending Spica. — Begin by first slightly flexing the hip on the side of the affected groin, then with a bandage 2^ to 3 ins. wide and 10 to 12 yards long, take a couple of s})ii'al turns round the upper fourth of the thigh, now make reverses up the thigh till the groin is reached ; then carry the bandage across the front of the groin outward and upward to a little above the hip joint, then across the small THE APPLICATION OF BANDAGES 49 of the back, and over the hip on the opposite side to the front of the abdomen, and across the pubes back again to the affected groin, then to the outside of the thigh round the back of it to the inside, and over the groin ; again across tiie body, and so on, making each turn go about half-an-inch higher than the lower edge of the preceding turn, and finally fix with a safety pin. (Fig. 23.) Fig. 23.— The "Ascending Spica' for tlie Groin. Fig. 24.— The " Descending Spica" for the Groin. (II) The Descending Spica. — Flex the thigh as before, then lay the free end of the bandage over the affected groin; now carry the bandage roni within outward across the hip on the same 50 FIRST AID TO THE INJURED side, taking care that it lies as high as possible (i. e.^ just below the brim of the pelvis) ; then pass it horizontally across the loins and round the hip on the sound side, then bring it obliquely across the front of the abdomen below the navel, over and round the thigh, and then again across the affected groin back to the first turn, and so on, causing each turn to lie on a lower level than the preceding turn and to overlap it by about two-thirds the width of the bandage. (Fig. 24.) The Spica for the Shoulder may also be applied in two ways ; — (I) From helow Upward^ as an "ascending spica," thus : Take a bandage 2^ to 3 ins. wide and 8 to 12 yards long, make a couple of spiral turns from within outward round the upper third of the arm on the affected side, now make reverses up the arm till the shoulder is reached ; then (after first placing a little cotton wool in both armpits), carry the bandage behind the shoulder across the back to the opposite side and under the armpit on that side, then across the front of the chest well up toward the top of the breast bone, then across the shoulder in a line with the reverses upon the bandage, then round the arm below the shoulder from behind for THE APPLICATION OF BANDAGES 51 ward to the front, and then across the back, and so on. (Fig. 25.) Fig. 25— The " Ascending Spica " for the Shoulder (II) From above Downward., as a "descend- ing spica," thus : After bringing up the band- age by means of reverses to the armpit, carry it over the front of the shoulder and as high up the neck as possible, then round the back to the op- posite side ; now under the arm on that side and across the front of the chest and the front of the arm on the affected side ; then under the armpit and over the shoulder again to the back, but this FIRST AID TO THE INJURED time on a lower level than the preceding turn, and so on. (Fig. 26.) Fig. 26.— The " Descending Spica " for the Shoulder. Spica for the Female Breast. — Take a bandage 3 to 4 ins. wide and 6 to 8 yards long, lay the free end of it about four inches below the affected breast, then make two horizontal turns round the body to fix the bandage ; now carry the band- age under the affected breast and over the op- posite shoulder, then down the back and again to the front on a slightly higher level than the preceding turn ; then horizontally across the body, and so on, till the whole breast is covered, THE APPJJCATION OF BANDAGES 53 the 'liorizontal and oblique turns being each time on a little higher level. Spica for the back of the Thumb. — This is the regular bandage for a sprain of the thumb and for liaBmorrhage from the part. Take a bandage not more than ^ inch wide and 1 to 2 yards iong, place the hand with the palm downward, lay the free end of the bandage below the root of the thumb and carry the bandage across to the back of, and round the wrist twice to fix it; now carry it upward from the root of the thumb to between the thumb and forefinger, then round the thumb as high as it will lie, then across the Fig. 27— The Spica for the Back of the Thumb. back of the hand, and round the wrist, back again to the root of the thumb ; then again 54 FIRST AID TO THE INJURED round the thumb, covering two- thirds of the former loop, then across the back of the hand, and so on ; bring the loops round the thumb a little nearer the wrist each time ; finally fix the bandage round the wrist either with a safety pin, or by splitting the end and tying. (Fig. 27.) Spica for the Great Toe. — This is applied in precisely the same way as the above, the ankle taking the place of the wrist. Divergent Spica for the Heel. — Take a bandage 2% inches wide and 4 yards long, place the free end of it across the outer ankle ; carry the roller under the sole to the inner ankle, and from here outward over the front of the instep to the point from where the bandage started ; now carry the bandage over the heel (placing the middle of the bandage over the most projecting part of it), then inward and across the front of the instep, and then under the sole of the foot, catching the lower edge of the loop which passes over the heel; now take the bandage over the front of Fig. 28.— Divergent Spica for the Heel. THE APPLICATION OF BANDAGES 56 the instep, then above the point of the heel, and over the upper loose edge of the loop which goes over the heel, back to the instep and again over the lower part of the heel, and so on, each loop over the point of the heel being a little further from the preceding one. Finish with a couple of spiral turns round the lower part of the leg. (Fig. 28.) Divergent Spica for the Elbow.— Take a band- Fig. 29.— Divergent Spica for tlie Elbow. age 1% to 2>^ ins. wide and 4 yards long, first flex the elbow, then carry the roller up the fore- arm by means of reverses till the elbow is reached, now place the middle of the bandage well over the point of the elbow, then carry it from within outward and catch the lower loose edge of the loop which encircles the point of the elbow, then take the bandage across to the inner side of the elbow, bring it from within outward again, and catch the upper loose edge 56 FIRST AID TO THE INJURED of the loop ; continue these figures of S from within outward alternately, making each overlap two-thirds of the preceding one. This bandage is emj)loyed when it is required to keep the fore- arm in a bent position, as after fractures and in- juries about the elbow joint. (Fig. 29.) Divergent Spica for the Knee. — First slightly flex the knee, then lay the free end of a bandage 2^ to 3 ins. wide and about 4 yards long, against the inner side of the knee and carry the roller over the front of the knee-cap to the outer side of the knee ami then back to the starting point ; then across the front of the knee, catching the lower loose margin of the turn above, then back to the starting point, and again across the front of the knee, i^2(7. 3o.-Divergent Spica this time catchiuff the upper for the Knee, , . p .1 r. ^ / loose margm or the nrst turn ; continue these figures of 8 above and below alter- nately. This bandage is used to give support to the knee joint when it is inflamed. (Fig. 30.) To Bandage the Upper Extremities proceed as THE A r rue AVION OF BANDAGES 57 follows : Take a bandage 2j/ inches wide and 10 to 12 yards long, make a couple of spiral turns round the wrist, beginning at the root of the thumb and passing outward over the back of the wrist ; then carry the bandage downward over the back of the hand to the root of the little finger ; now take one turn round the fingers, Fig. 31.— The Upper Extremity Bandaged. leaving the tips free, then make a figure of 8 round the back of the hand, and repeat it three or four times ; then carry the bandage by spiral turns upward till the thick part of the forearm is reached, then apply the reverse spiral till the bulging of the forearm begins to diminish, now flex the elbow, make a figure of 8 round it, 58 FIRST AID TO THE INJURED leaving the point free, unless it is injured, in which case cover it, then make a few spiral turns round the lower part of the upper arm, then carry the bandage up by reverse spirals to the armpit, and secure the end with a safety pin. (Fig. 31.) Note. — Never bandage the forearm and arm in a straight position and then flex the elbow afterward, as this will produce compression of the veins and lead to swelling of the hand and fore arm, and subsequent mortitica- tion. Finger Bandage ; — The Continuous Finger Bandage. — Take a bandage % inch, or, still better, ^ inch wide, and 4 yards long. Make a turn round the wrist leaving about 6 ins. of the end free, carry the bandage over the back of the hand to the outer side of the little finger, with a single turn take it well up to the level of the nail, then make spiral turns round the finger to the root, then carry the bandage across the back of the hand round the wrist, and again across the back of the hand to the root of the ring finger, now proceed success- ively with this and each of the other fingers, covering them in the same way as the little 2'HE APPLICATION OF BANDAGES 59 finger till all are covered, and then tie the band- age with the loose end (Fig. 32). This bandage Fig. 32.— The Continuous Finger Bandage. is used to prevent swelling of the hand when splints and dressings are applied to the forearm. It should always be applied before other band- ages are put on higher up. It is also of great use for burns and scalds of the fingers. Any one finger may be bandaged in a similar manner to the above. To Bandage the Lower Extremity proceed as follows : Take a. 2}4 inch bandage, 10 to 12 yards long. Extend the leg and place the foot at right angles to it ; lay the free end of the bandage over 60 FIRST AID TO THE INJURED the inner ankle, now cany the roller over the instep to the root of the little toe, then across the sole of the foot to the ball of the great toe, then, over the instep and the outer ankle, round the back of the heel, across the inner ankle and over the front of the instep to the root of the little toe, then across the sole of the foot to the ball of the great toe, and then across the top of foot at the base of the toes round the sole of the foot and back again to the ball of the great toe ; now make two reverses round the lower part of the foot, these reverses being opposite the middle of the top of the foot, then make two figure of 8 turns round the ankle ;ind heel, then make three spiral turns round the h)wer part of the leg and ankle, then carry the bandnge upward by reverse spirals till the knee is reached, now make figure of 8 turns round the knee joint, either covering it in or leaving it free, Fig. 33.— The Lower Limb Bandage. THE APPLICATION OF BANDAGES 61 then carry the bandage up the thigh by reverse spirals, finish and secure the end with a safety pin. (Fig. 33.) Bandages for the Head. (I) The Capeline Bandage,— T^lVq two roller bandages, one 2 ins. wide and 6 yds. long, the other 1% ins. wide and 5 yds. long. Sew the free ends together, this will form a double-headed roller. Make the patient sit on a low chair, stand behind him holding the wide roller in the right hand and the narrow roller in the left hand ; now place the middle of the double- headed roller against the centre of the forehead, and carry the roller backward one on each side above the ears, and below and behind the occiput, cross hands passing the narrow roller over the wide one, now change rollers taking the wide roller in the left hand and the narrow roller in the right hand ; draw the bandage tight, carry the wide roller upward along the top of the middle of the head to the root of the nose, and bring the narrow roller horizontally forward above the right ear, and across the wide roller at the root of the nose; now carry the wide roller back across the top of the head a little to the left of the middle line (Fig. S-i), fix it behind as in front 62 FIRST AID TO THE INJURED Fig. 34. Fig. 34a. Fig. Ub. Figs. 34, 34a, 346.— The Capeliue Bandage. THE APPLICATION OF BANDAGES 63 by the narrow roller, then bring it over to the front across the head a little to the right of the middle line (Fig. 34^), again fix it by the narrow roller, and continue these operations backward and forward, each time making the bandage which is covering the top of the head diverge a little from the middle line till the ears are reached ; now cut off the vertical bandage in front, and fix by taking two extra turns with the horizontal bandage round the head and pinning on one side. (Fig.34J.) This bandage is used for fixing dressings on the head. Its disadvantages are: that it is troublesome to apply ; it is hot, and if put on too tightly it becomes painful. (II) The Twisted or Knotted Bandage. — Take a bandage 2^ inches wide and 8 yards long, un- roll it for about 1 foot, hold the free end in the left hand ; place the bandage against the left temple, carry the roller round the forehead, across the opposite temple, then below the occi- put, and bring it back to the unrolled end, now twist it round this end sharply, and carry it vertically upward round the vertex (Fig. 35) down the side of the face under and over the jaw till the unrolled end is reached; now twist it 64 FIRST AW TO THE INJURED round this again, and carry it obliquely midway between the two preceding turns (Fig. 35{^), Fig. 35. Fig. 35a Figs. 35, 35a, .^%.— The Twisted Fig. Zlb n- Knotted Handage. round the head to the starting point ; then make another twist and take it vertically round the head. Repeat these oblique and vertical turns alternately till sufficient pressure is obtained, and fix the bandage by knotting the two ends to- gether. (Fig. 35?a) This bandage is used to exert pressure on a graduated compress placed over a bleeding wound THE APPLICATION OF BANDAGES Or, of Liiu temple, and for retaining dressings on the front of the head. To Bandage the Chest. — A bandage applied to the chest has a tendency to slip down ; to avoid this a brace is used and the bandage is applied from below upward. Therefore proceed as fol- Fig. 36. Fig. 36a Figs. 36, 36a.— The Cliest Bandage. lows : Take a roller 6 inches wide and G to 8 yards long, slit the free end down the centre to about 2i^ feet, place the bandage with the roller touching the back and the slit ends lying well over the shoulders and in front of the chest, now m FIRST AID TO THE INJURED turn the bandage at right angles at the lower part of tlie back, and make spiral turns over tlie free ends and round the chest from behind forward, and from below upward, each spiral overlapping the one below it by about one half its breadth (Fig. 36) ; when the desired level is reached secure the last spiral with a safety pin in front and be- hind ; now double the free ends over the applied bandage and pin each end to the corresponding .bandage on the shoulder. (Fig. 36^/.) To Bandage the Abdomen, proceed in the same way as for the chest, but bandage from above downward. This bandage is best made of flannel. Table Showing the Kinds of Rolleu Bandage to be Applied to Different Parts Part to be Band- aged. Kind of Ba to use ndage Object of the Bandage Applied. I. The Head The Capeline The Twisted or Knotted To retain dressings 'lo exert pressure on a gradu- ated compress or paii placed over bleeding wound and to retain dressings 2. The Chest The Spiral - - To give support, exert pres- sure or retain dressings 3, The Kieast 4. The Abdomen - The Spica - ihe Spiral - " To give support To give support, exert pressure or retain dressings 5, The '1 huiiib The Spica - ■ For sprain of the thumb, or to arrest haemorrhage from the part THE APPLICATION OF PANDA GES 67 Par/ to I'fi Ba?ui- aeed. L'he Fingers 7. The Hand 8. The Wrist 9. The Forearm - 10. The Elbow (a) To cover the point Kind 0/ Bandage to use The Spiral, known as the Continuous Fin- ger bandage The Figure of 8 The Spiral - The Reverse Spiral The Divergent Spica Object qfthe Bandage Applied. To retain dressings, especially in case of burns or scalds, or to prevent the fingers from swelling when splints or dressings are applied to the forearm To retain dressings, fix splints, etc. Ditto Ditto To keep the forearm in a bent position, as in fractures, or in injuries about the elbow joint (<5) To leave the The Figure of 8 To retain dressings or exert point uncovered pressure II. The Upper Arm (a) For the lower The Spiral - To retain dressings, fix splints, part etc. (^) For the upper The Reverse Spiral Ditto part 12. The Shoulder The Spica - To retain dressings, or to exert pressure 13. The Great Toe The Figure of 8 For sprains, or haemorrhage from the part 14. The Foot The Figure of 8 fol- To retain dressings, or exert lowed by the Spiral pressure, or fix splints and the Reverse Spiral 15. The Heel (rt) To cover the The Divergent Spica Ditto point {b) To leave the The Figure of 8 Ditto point uncovered 16. The Ankle The Spiral - Ditto, or to fix splints 17. The Leg The Reverse Spiral Ditto 18. The Knee («) To cover it in The Divergent Spica To give support to the joint when it is inflamed {b) To leave it The Figure of 8 To retain dressings uncovered 19. The Thigh The Reverse Spiral To retain dressings, or to fix splints 20. The Groin The Spica - To retain dressings, or to exert pressure 68 FIRST AID TO THE INJURED BANDAGES OF SPECIAL FORM AND THEIR APPLICATION 1. The Square Bandage. — This is used as a protection for the entire head and neck. Take a handkerchief a yard square, and fold in two so as to allow the under layer to project about 4 inches beyond the upper ; lay the middle of the bandage upon the top of the head, with the larger flap covering the eyes, the margin of the upper flap in a line with the eyebrows, and the short borders hanging upon the shoulders (Fig. 37) ; now take the two outer corners, pass them below the inner ends and tie them in a reef knot firmly under the chin (Fig. 37^), turn the border of the under layer over the forehead, take its two corners, carry them backward and tie in a reef knot behind the head. (Fig. 37J.) 2. The Four-Tailed Bandage.— This is used to keep a dressing on the chin, the top, back, or front of the head, and on the knee; it is also used for a broken jaw. (I) The Fo%ir-Tailed Bandage for the Jaio. — Take 1 % yds. of a 3-in. roller, make a longitudi- nal slit in the centre of it about 3 ins. Ions: and then slit down the ends to within 6 ins. of the centre. Place the chin in the centre slit, then THE APPLICATION OF BANDAGES Fig. 37. Fig. ^la. Fig. 37&. Figs. 37, 37a, 37&.— The 8(iiiare Bandage. 70 FIRST AID TO THE INJURED carry the two lower ends to the top of the head and tie them ; carry the two upper ends behind the neck and tie them (Fig. 38) ; now tie the ends to each other behind the head. (Fig. 38a.) Fig. 38. Fig. 38a. Figs. 38, 38a.— The Four-tailed Bandage for the Jaw. (II) The Fotir- Tailed Bandage for the Read, the " four tailed cap." Take a piece of calico 6 to 8 ins. wide and 3 feet long, and slit up the ends to within 2 inches of the centre. {a) To apply it to the front of the head : Place the centre of the bandage upon the top of the head, carry the two anterior ends backward over the ears and tie them below the occiput, then carry the two posterior ends forward and tie them under the chin. (Fig. 39.) THE ArPLICATION OF BANDAGES {])) To apply it to the back of the head : Place the centre of the bandage upon the back Fig. 39. Fig. 39a. Figs. 39, 39a.— The Four-tailed Bandage for the Head. of the head, carry the two u[)per ends downward and tie them under the chin, then carry the two lower ends forward and tie them in front on the forehead. (Fig. 39».) (Ill) The Four-Tailed Bandage for the Knee. —Take a piece of calico 6 to 8 ins. wide and 3 ft. long, and slit it down the narrow ends to within 2 ins. on each side from the centre. To apply it : Lay the centre of the bandage upon the knee- cap, cross the ends behind the bend of the knee, the upper ends below the lower, then bring the 72 FIRST AID TO THE INJURED ends forward, tie the two upper ones above the knee-cap and the two low^er ones below it. (Fig. 40.) 3. The Many-Tailed Band- age (Bandage of Scultetus). — This is employed in cases where it is advisable not to disturb a limb more than is necessary. For the bandage the widths required are — ^]^ ins. for the arm, and 3j^ ins. for the leg. To make the bandage : Take a stiip as k)ng again as the part it is required to cover, spread it out, now lay strips 6 ins. longer than the part required to be covered across the upper half of the perpen- dicular strip, with their centres along the centre of this strip ; make these cross strips overlap each other by about one-third of their width, and sew them to the perpendicular strip. To apply the bandage : Lay the limb along the upper half of the central strip, draw the lower half of the central strip over the front Fig. 40.— The Foui-tailed Bandage for the Knee. THE APPLICATION OF BANDAGES 73 of the limb (Fig. 41), fold the cross strips over from below upward somewhat obliquely, and secure the last two strips to the two below by a safety pin. (Fig. 4:1a.) Fig.i\. Fig.iia. Figs. 41, 41a.— The Many-tailed Bandage. 4. The T Bandage. — This is used to retain dressings on the perinaeum. It is made by taking a bandage 3 ins. wide by ly^ yards long, and 74 FIRST AID TO THE INJURED sewing it at right angles to the centre of a similar strip 1 yard long. To apply the band- age : Pass the long strip round the waist above the hips, so that the short strip lies along the sacrum, and pin the ends in front ; now bring the short strip forward between the thighs and pin it to the long strip in front. (Fig 42.) Fig. 42.— The T Bandage, CHAPTER III lI.EMORRIIAGE AND ITS IMMEDIATE TREAT- MENT Hajinorrliage — DefiniMon, Causes, Situation, Symptoms, aud Varieties of — The Treatment of Capillary Haemorrhage — The Treatment of Venous Haemorrhage — The Treatment of a Bmst Varicose Vein — The General "First Aid" Treat ment of Arterial Haemorrhage — First Aid Methods of Controlling Arterial Haemorrhage— Digital Compression, the points where the chief vessels may be digitally com- pressed — Forced Flexion of a Limb, Esmarch's Band, Tourniquets (Improvised, Volker's, Screw and Field) — The Treatment of Constitutional Symptoms — The Immediate Treatment of External Haemorrhage — Internal Haemor- rhage, its Causes, and the Means to be adopted for its Treatment — Blood Spitting, Blood Vomiting, and Nose Bleeding, their Causes and Treatment. Definition.— Hsemorrhage may be defined as tiie escape of blood from the heart or the blood- vessels. The Causes are : — (I) Injury; (II) Disease. The Situation. — Haoraorrhage may be either : — (I) External. — This is most frequently the re- sult of injury. 75 7(J FIRST AID TO THE INJURED (II) Internal. — This is general I \^ due to disease affecting the blood-vessels, or their neighboring structures. The Symptoms of HaBinorrhage are: — The actual appearance of blood (which is always seen in external haemorrhage, while in internal haemorrhage blood may also reveal its presence — e. g.^ in bleeding from the lungs, etc.), and the constitutional effects, more or less, which follow the loss of blood, i. ^., the signs of syncope or fainting, which are indicated by a cold and clammy skin, a pallid and livid face, dilated pupils, feeble and irregular breathing, an irregular and almost imperceptible pulse, dizziness, inclina- tion to vomit, and loss of consciousness. These constitutional effects are in direct proportion to the suddenness of the loss of blood, i. e., the quicker the loss the more profound the syncope. Varieties of Haemorrhage. — The severity of the bleeding varies with the portion of the vascular circuit which is wounded, and haemor- rhage presents different characteristics according to its origin from capillaries, veins or arteries respectively : — 1. Capillary. — This is the least dangerous form ; it is indicated by a general oozing from n.EMORRHA GE A ND ITS IM MEDIA TE TREA TMENT 77 the whole surface of a wound, and the color of the blood is more or less brick red. 2. Venous. — This is indicated by the blood flowing in a continuous stream, and issuing from the cut end of the vessel furthest from the heart, i. e.^ in the limbs from below the wound, the color of the blood being a dark purple. Venous haemorrhage comes next in seriousness to arterial. 3. Arterial. — This is the most serious form of bleeding ; it is indicated by the blood flowing in a forcible pulsatile stream (which rises with each beat of the heart and falls in the interval), and issuing from the cut end of the vessel nearest the heart, i. e.^ in the limbs from above the wound, the color of the blood being a briglit scarlet. EXTERNAL HiEMORRHAGE I. The Treatment of Capillary Haemorrhage. — Expose the part to the air and apply pressure to the wound to close the vessels, and prevent further escape of blood. This may be done by means of a perfectly clean finger, or a clean bit of sponge or lint. If the above means are not sufficient, encourage coagulation of blood, so 78 FIRST AID TO THE INJURED that the clot may seal the cut vessels ; this may be done by the application of clean cold water, or hot water at a temperature of 100° to 120° F., or by first drying the part and then applying a styptic, such as common salt, burned or dried alum, tincture of steel, turpentine, tannic or gal- lic acid. Friar's balsam, tincture of eucalyptus, etc. Note. — Styptics are not to be applied too strong, otherwise they destroy the vitality of the tissues. 2. The Treatment of Venous Haemorrhage. — In treating bleeding from veins, adopt the fol- lowing measures, viz. : — (I) Remove all constrictions which impede the backward flow of blood to the heart, i. e., all tight clothing about the chest and neck must be loosened, garters undone, etc. (II) Elevate the bleeding part if possible above the level of the heart, i. e., if the bleeding is from a limb, raise it. (III) Apply first digital pressure (pressure with perfectly clean fingers), directl}^ to the sur- face of the wound, and then place a clean pad on the wound and keep it in position by a band^ age. HA'LMOURHA GE A NI) ITS HTMEDIA TE TREA TMENT 7i> (IV) Keep the wounded part in an elevated position (if possible) for some hours after the bleeding has stopped. The Immediate Treatment of a Burst Yari- cose Vein. — The superficial veins of the lower extremity are liable to become dilated or vari- cose, from the incompetency of their valves and the consequent undue pressure of the column of blood upon their walls ; these dilated veins may burst, producing serious or even fatal haemor- rhage if not promptly attended to; the meas- ures therefore to be adopted in dealing with a condition of this description are as follows : — (I) Place the patient at once on his back. (II) Kemove all constrictions round the limb on the heart side. (III) Raise the wounded leg. (IV) Expose the bleeding surface, place a clean pad directly on the wound and fix it, by means of a triangular bandage. (V) If the patient has to be removed, carry him on a stretcher, lying on his back with his foot raised. (VI) Keep the patient in a recumbent position with the foot raised for some hours after the ac- cident. 80 FIRST AID TO THE INJURED i\ 1 1) If the bleeding has been at all excessive keep the patient warm, in order to counteract any sudden failure of the heart's action. 3. Treatment of Arterial Hsemorrhage In arterial bleeding the force of the heart's beat pumping the blood through the cut vessel ])re- vents any chance of clotting, therefore the two main factors in stopping bleeding are : — (I) To place the bleeding part, if possible, in a proper position, i. e.^ above the level of the heart, at the same time expose the wound to the air, and remove all constrictions which impede the return of venous blood. (IT) To apply pressure to the wound itself or to the main artery supplying the part. Pressure shouhl always first be applied with the thumb and finger (digital pressure), so that no time is lost in getting appliances. To aid the above means, the patient should be kept absolutely quiet and in a recumbent position. Sliould there be any constitutional symptoms (syncope), these must be treated {see page 193). " First Aid " Methods of Controlling Arterial Haemorrhage. — The measures to be adopted will depend npon the severity of the bleeding. JUCMuh'R 11 A GE A ND ITS IMMEDIA TE TEE A TMENT 81 1. If tup: Bleeding is not Excessive, i. e., in iiU superlicial haemorrhages apply : — (I) Firm pressure directly to the bleeding- point by means of absolutely clean fingers, and when the bleeding has quite stopped, place (II) A clean pad over the wound and keep it in position either by means of a folded triangu- lar bandage, or by a roller bamlage. In some situations, e. gr., the palm of the hand, a graduated compress (made by superimposing several layers of clean lint upon each other, the smallest piece being about the size of a sixpence and the largest that of a shilling) is more effect- ive than a simple pad. 2. If the Bleeding is Excessive, apply if possible : — (I) Digital Comjjy'ession (compression by means of the fingers) to the main artery supply- ing the part with blood. This pressure is ap- plied to the artery between the wound and the heart, and at a point where some hard basis of support is furnished, against which the artery can be pressed, e. g., where the vessel passes over or along a bone. The great value of digital compression is that it can be applied immediately. In digital com- 82 FIRST AID TO THE INJURED pression the following points are to be remem- bered : — (ct) To use the thumb to make the pressure. {h) Having ascertained the position of the artery by its pulsation, get it fairly against the bone, and press directly upon it, using sufficient force just to stop the bleeding but not to cause the patient any pain. {c) Compress if possible the artery only, avoiding all adjacent structures such as veins and nerves. Digital compres- sion is onl}^ applicable in certain parts of the body, viz., the limbs, the neck, and some parts of the head and face, and it cannot be effectively maintained by one person for more than about lif- teen consecutive minutes at a time. (II) Replace Digital Coiiq^ression by applying a hard pad upon the artery, and keeping it in position by a bandage. The follo'winy vessels may he digitally com- pressed^ viz. : — I. The Temporal Artery. — This passes over the zygoma, and may be best compressed at a point one finger's breadth in front of the open- 7< E210ERHA QE A KD ITS niMED TA TE TREA T3TENT 83 ino^ of the ear, pressure being applied directly ae:ainst the bone. (Fig. 43.) Fig. 43.— Compression of the Temporal Artery Fig. 44.— Compression of t.ie Occipital Artery. 2. The Occipital Artery. — This passes over the mastoid process, and can be best compressed at a point two fingers' breadth from the centre of the back of the ear, pressure being applied di- rectly backward. (Fig. 44.) 3. The Facial Artery. — This passes over the lower jaw, and can be best compressed at a point one inch in front of the angle of the jaw, pressure being applied directly backward. (Fig. 45.) 4. The Common Carotid Artery. — This passes along the side of the neck, from a point midway between the angle of the jaw and the mastoid 84 FIRST AID TO THE INJURED process to the sternal end of the clavicle; it can be best compressed at a spot one and a half inches Fig. 45.— Conipiession of the Facial Artery Fig. 46.— Compression ot ilie Carotid Artery above the joint between the sternum and the clavicle, pressure being applied inward and backward. (Fig. 46.) 5. The Subclavian Artery. — This passes across the upper surface of the first rib ; it can be best compressed at a point behind the middle of the clavicle, pressure being applied downward and backward after first depressing the shoulder, either with the thumb (Fig. 47), or with the han- dle of a door key padded. (Fig. 48.) 6. The Axillary Artery.— This passes over the apex and along the outer side of the axilla; it ILEMOERHA GE A ND ITS IM3IEDIA TE TEE A TMENT 85 can be best compressed at the junction of the outer with the middle third of the armpit, pres- Fig. 47.— Compression of the Sub- clavian with the Tiiumb. Fig. 48.— Compression of Sub- clavian with tlie Handle of a Door Key Padded. sure being applied outward and backward after first raising the arm. (Fig. 49.) 7. The Brachial Artery. — This passes along the inner border of the biceps muscle, in a line with the inner seam of the coat ; it can be best compressed in the middle of the arm, pressure being applied outward and backward. (Fig. 50.) 8. The Radial and Ulnar Arteries. — Tliese pass alono' the outer and inner borders of the wrist respectively ; they can be best compressed at a point one inch above the wrist on each side, pres- 86 FIRST AID TO THE INJURED sure being applied directly backward. (Fig. 51.) The Femoral Artery. — This passes over the cen- Fig. 49.— Compression of Axillary Artery. tre of the pubes (here it is known as the common femoral) and then along a line drawn from the Fig. 50.— Compression of the Brachial Artery. middle of the bend of the groin to the back of the internal condyle of the femur (here it is H.EMOBK HA GE A NI) ITS IM MEDIA TE TEE A TMENT 87 known as the superficial femoral) ; it can be best compressed, either at a point midway between {1^^: Fig. 51.— Compression of the Radial and Ulnar Arteries. the symphisis pubis and the iliac spine, pressure being applied directly downward (Fig. 52), or lower down in the middle of the thigh, pressure being applied outward after the knee has been first flexed and the thigh rotated outward. (Fig. 53.) N'ote. — In compressing the femoral arter}^, the operator should stand well over the patient and should apply the pressure with both thumbs one upon the other. 10. The Popliteal Artery. — This passes along 88 FIEST AW TO THE INJURED the middle of the ham ; it can be best compressed in tlie centre of the middle of the ham, pressure being applied directly forward. \ Fig. 52.— Compression of the Conunon Femoral Artery 11. The Posterior Tibial Artery. — This passes below the internal malleolus ; it can be best com- pressed at a point a thumb's breadth from the internal malleolus, pressure being applied for- ward and outward. 12. The Anterior Tibial Artery. — This passes ILEMORRHA GE A ND HIS IMMEDIA TE TBEA TMENT 89 along the middle of the front of the ankle ; it can be best compressed at a point midway between Fig. 53.— Compression of the Superficial Femoral Artery. the two malleoli, pressure being applied back- ward. Forced Flexion. — In bleeding from the limbs digital compression of the artery can be super- seded by compression of the artery by forced flexion of the limb, i. e., by bending the main 00 FJnST AID TO THE INJURED Temporal artery Occipital artery Facial artery Commcn carotid artery Subclavian artery -Arch ot the aorta Axillary artery Brachial artery Abdominal aortft Common iliac artery Common femoral artery Radial artery Ulnar artery 1 Superficial arcb - Superficial femoral artery Popliteal artery .Anterior tibial artery Posterior tibial artery Fig. 54— Diagram lo show the course of the Chief Vessels. (The arrows indicate the points where, and tlie diiection in which pressure can be applied most effectively.) 1L1DI0URHA GE AND ITS IMMEDIA TE THE A TMENT 91 artery acutely over a pad placed in the joint above the wound. The joints where this method can be used are : the armpit (Fig. 55), the bend of the elbow (Fig. Fig. 55.— Compression of the Axillary Artery by Forced Flexion. 56), the fold of the groin and the bend of the knee. (Fig. 57.) Mode of Procedure. — Place a hard pad, not too large, in the joint above the wound, flex the 92 FIRST AID TO THE INJURED limb over the pad, and tie it to tiie part above by means of a triangular bandage folded narrow. Fig, 56.— Compression of the Brachial Artery by Forced Flexion. Forced flexion is uncomfortable, and if the pa- tient is left alone, he may pull the bandage to re- lieve the discomfort and displace the pad, caus- ing the bleeding to recommence, therefore. Con- striction of the whole limb above the bleeding point is better ; this can be effected by : (I) A Narrow-Fold Triangular Bandage tied loosely in a knot round the limb, and then twisted round several times by means of a stick inserted into the loop to make it tight, or (II) By EsmarcNs Elastic Band or Ttibe^ which are applied as follows : First, a turn of a wide Roller bandage is fixed round the limb IJ.miORRHA GE A ND ITS IM3TEDIA TE THE A TMENT 93 where the band (or tube) is to be applied iii order to protect the skin ; the band (or tube) is Fig. 57.— Compression of the Popliteal Artery by Forced Flexion. then well stretched, the limb encircled with it at this spot two or three times, and the ends are then either tied, or hooked off. Caution. — In applying Esmarch's Band care must be taken that it is just tight enough to stop the circulation and nothing more. The disadvantages of the above method (con- striction of the whole limb), are: That complete arrest of the blood supply to the parts below the constriction favors a tendency to mortification of 04 FIJiST AID TO THE INJUIiEI) the limb, therefore, in preference to constriction, tourniquets should be used. Fig. 58. Tourniquets are instruments con^t<*ucted on the principle of a strap to encircle tbc limb, a pad to place on the artery, and a screw, buckle oi- other means to tighten the strap. The advantnge of a tourniquet is that effect! i'-c pressure can be applied to the main artery ^vithout undue con- striction of the whole limb. The kinds of tourniquets most suitable are : The htijrrovised Tourniquet or Garrot. — This is made by folding a Triangular bandage or nn ordinary handkerchief like a cravat, and placing some hard substance (such as a cork out of a wine bottle) in its folds, to act as a pad ; the pad is IT.EMORRHA GE A ND ITS IMMEDIA TE TEE A TMENT 1,5 [Jaced on the vessel, the handkerchief is tied oosely once over a soft pad, placed against the Fig. 58a. Fig. 58a.— The Improvised Tourniquet applied to the Thigh. limb on the opposite side to the knot, a stick is placed in the tie and the bandage knotted over it, the stick is then twisted round several times Fig. 59.— Volker's Stick Tourniquet Applied. 90 FIRST AID TO THE INJURED till the vessel is compressed (Fig. 58), and then after first placing the pad under it, it is tied to the limb by means of another triangular band- age folded narrow. (P^ig. 58^.) Volker^s Stick Tourni<2uet. — This can be ap- plied only to the arm ; it is made by taking two sticks G to 8 inches long, ^ inch thick, and notched at the ends; after first encircling the limb with a couple of turns of a roller bandage at the spot where the vessel is to be compressed, one stick is placed on the artery, and the other Fig. 60.— EsiiKuchs Touniiqiiet on the opposite side to it, the two are then tied together at their ends, top and bottom. (Fig. 59.) Esmarcli's Tourniquet. — Figure 60 sufficiently explains the construction of this ; it is applied in B.l^MO mill A a K A ND ITS IM3IEDIA TE THE A T3IENT r<7 the same manner as Esmarch's band. (Fig. 61.) The Field Tourniquet. — This has the disad- vantage that it can never be drawn tight enough and the pad is therefore liable to slip. Fig. 61.— Esmarch's Tourniquet Applied. The Screw Tourniquet. — This tourniquet is provided with a screw, by means of which it can be further tightened after buckling, and it is therefore a more efficient instrument. A tourniquet may be safely kept on for three hours, but if the bleeding has entirely stopped it is better to loosen the tourniquet slightly after an hour's application, taking care to ngain tighten it up should the haemorrhage recur. The Treatment of Constitutional Symptoms. — In order to counteract syncope or fainting due to 98 FIRST AID TO THE INJURED the loss of blood, the patient must be kept at absolute rest in a recumbent position with the feet slightly raised ; his clothes should be re- moved, his body should be wrapped in warm blankets, and hot- water bottles should be applied to his feet. If able to swallow, stimulants well diluted are to be given in small quantities, but only after the haemorrhage has entirely stopped. If the loss of blood has been very excessive, the breathing may become embarrassed, or may actually stop ; artificial i-espiration after the Sylvester method must then be resorted to. HJ^MOHRHA GE AND ITS 13131 EDI A TE THE A TMENT 99 I'ait Wounded. 1 riie Temple, Mie Front or t.ie Top of tlie Head The Back of tlie Head 3. The Face be- low the Eyes 4. The Neck - 5. Tlie Shoulder or the Axilla The Upper Tiilrd of the Arm 7. The Lower T w o - 1 li i r ds of the Arm Artery to Compress. The Temporal The Occipital The Facial The Conniion Carotid The Subclavian The Axillary The Brachial Passes over the zygoma Passes over the mastoid proc- ess Passes over the lower jaw Pusses along tlie side of the neck, from a point midway between the angle of the jaw and tlie mastoid proc- ess to the sternal end of the clavicle Passes across the upper sur- face of tlie first rib Passes over the apex and a long the outer side of tlie axilla Passes along the inner border of the biceps muscle, in a line with tiie inner seam of the coat Point where Pressure is to be applied. One finger's breadth iv front of the openin of the ear Two fingers' breadth from tlie centre of the back of the ear One inch in front of the angle of the jaw One and a half inches above the sterno-cla- vicular joint Behind the middle of tlie clavicle At the junction of the outer with the middle third of the armpit The middle of the arm loo FIRST AID TO THE INJURED Direction of tlie Pressure. Directly against the bone Ditto - Ditto - - - - Inward aiul backward against tlie trans- verse process of tlie sixth cervical ver- tebra iVo^e.— This vessel requires considerable care to compress, pressure on the neighboring struc- tures (nerve, vein, trachea, etc.), must be carefully avoided. With the slioulder and clavicle depressed, downward and back- ward agaJTist the upper surface of the first rib With tlie arm raised, outward and back- ward against the humerus Outward and back- ward against the humerus Kind of Pressure to be employed. ligi nlai then a pad placed on the artery and retained in position by means of a narrow-fold twisted triangular bandage, or a knot- ted roller bandage First digital, then a pad on the artery, and retained in position by a narrow-fold triangular bandage Ditto - - - . Digital Digital first and then the handle of a door key padded Digital first and then forced flexion Digital first and then either Volker's stick tourniquet, or forced flexion, i. e., a firm pad in axilla and arm bandaged to side of chest, or by Esmarch's band or a tourniquet (impro- vised, screw, or field) Subsequent Treatment after theHaemorrliage has stopped. Dress the wound, placing a linn clean pad over it Ditto Ditto When the bleeding hascom- pletely stopped, dress the wound, bend the liead for- ward u|)on the chest and fix it in tills position by means of bandages and pillows Dress the wound, apply a sj^ica bandage to the shouldei- to retain the dressings and place the forearm in a large arm sling Ditto Dress the wound and place the forearm in a large arm sling H.EMOURHA GE A ND ITS IMMEDIA TE TREA T3IENT 101 Part Wounded. Artery Course of the Point where Pressure is to Compress. Artery. to be applied. 8. The Forearm The Brachial - Under the inner edge of the tendon of the biceps muscle At the bend of the elbow 9. The Palin of Tlie Kadial and Along the One inch above the wrist the Hand the Ulna outer and tiie inner borders of the wrist respectively on each side 10. The Upper The Common Passes over the At the bend of the groin Tlihd of the Femoral pubes midway between the Thigh symphysis and the iliac spine 11. The Lower The Superficial Passes along a The middle of the thigh Two-thirds of Femoral line drawn the Thigh from the mid- dle of the bend of the groin to the inner side of the knee 12. The Leg - The Popliteal - Along the mid- dle of the ham In the centre of tlie iiam 13. The Foot - The Posterior Below the in- A thumb's breadth from Tibial ternal malle- olus the internal malleolus The Anterior Middle of the Midway between the two Tibial front of the ankle malleoli 102 FlRtiT AID TO THE INJURED Direction of tlie Pressure. Downward and back- ward agaiust the humerus Directly backward against the radius and tlie ulna Di rect I y d o w n w a r d against the pubes With the knee slightly flexed and the thigh rotateci o u t w a r d , outward against tlie femur Directly against the posterior surface of the lower end of the femur Forward and outward against the tibia Backward against tlie tibia Kind of Pressure to be employed. Forced flexion at the bend of the elbow Digital Digital with both thumbs one upon the other, or forced flexion with a firm pad on the artery Digital first with both thuml)S one upon Iht^ otiier. and then Esmarcli's band or a tourniquet Forced flexion at the bend of the knee A pad placed on each vessel and a band- age tied round the ankle to retain the pads in position Subsequent Treatment after the Haemorrhage has stopped. Dress the wound and sling the elbow Dress the wound, place a hard pad in the palm, bend the fingers over it and bandage them to the hand, then place a firm pad in the bend of the elbow, flex the forearm upon the arm and sling the elbow with the injured hand rest- ing against the oi)posite shoulder Dress the wound, fix the pad on the artery and the dressings on the wound with a spica bandage to the groin, then apply a long splint to the outer side of the injured limb, and keep tlie patient in a recumbent position with the foot slightly raised Dress the wound, apply a long splint to the outer side of the injured limb, and keep the patient in a recumbent position with the foot slightly raised Dress the wound and keep the patient in a recumbent position Dress the wound and keep the foot slightly raised HJ^3I0RBHAGE AND ITS IM3IED1A TE TEE A TMENT 103 INTERNAL HAEMORRHAGE The Causes of internal haemorrhage are : — (I) Injury from blows, punctured wounds, severe crushes, and falls from a height causing bruising and laceration of internal organs. (II) Disease producing weakening and then bursting of a blood-vessel. The blood in internal haemorrhage may either escape into one of the closed cavities of the body, such as the abdomen, cranium, or thorax, or it may make its escape externally through an open- ing in the body, artificial or natural. Serious haemorrhage into a closed cavity is denoted by the history of the accident and the signs of syncope or fainting. The measures to be adopted in a condition of this description, are: — (I) To send at once for medical assistance. (II) In the meanwhile to treat the constitu- tional symptoms which are due to the loss of blood. When blood makes its escape through one of the natural openings of the body, it may take the form of : — (i) Blood Spitting : (2) Blood Vomiting / {3) Nose Bleeding. 104 FJIiST AID TO THE INJURED I. Blood Spitting. — This may proceed from : — (a) The Mucous Membrane of the Mouthy especially tlie gums, or from the cavity left after the extraction of a tooth. Treatment. — If the bleeding is slight, the patient must wash his mouth out with hot water, as liot as it can be borne, or with a solution of alum, or with a strong solution of salt and water, or small pieces of ice must be given him to suck. If the bleeding is from the socket of a tooth, plug it well with a pledget of cotton wool which has been dipped in a solution of salt and water. If the bleeding is severe, apply pressure directly to the bleeding point if possible, by means of a small pad of clean lint. (Z») The Throaty caused by injury to the wind pipe or gullet. Treatment. — Keep the patient quiet in a re- clining position, and give him small pieces of ice to suck at frequent intervals. (c) The Posterior Surface of the Mucous Memhrane of the Nose. Treatment. — (See Bleeding from the Nose.) {d) From the Lungs {Ilmmojytysis). — Bleeding from the lungs is indicated by scarlet and frothy blood being coughed up in mouthfuls. It is ILKMORRHAGE AND ITS IMMEDIATE TUEAIMENT 105 usually the result of either disease of the lungs or injury to the ribs. Treatment.— (I) Send at once for medical- assistance, in the meanwhile — (II) Lay the patient down on his side with his head and shoulders slightly raised on a pillow ; keep him absolutely quiet, and prevent him from talking or making the slightest ex- ertion. (III) Open the windows and admit plenty of fresh, cool air into the room. (lY) Give the patient ice to suck, or let him sip cold water, or vinegar and cold water, or a strong solution of alum and water, or strong cold tea with a lump of ice in it. (V) Remove all constrictions round the pa- tient's chest, and apply cold to it either by means of an ice bag, or a cloth which has been rung out in ice-cold water. (YI) If the faintness is severe, be cautious in the administration of stimulants. (YII) Apply smelling salts to the nostrils, and warmth to the feet. 2. Blood Vomiting (Hsematemesis). — This is usually caused by disease affecting the walls of the stomach. 106 FlliiiT Alb TO THE INJURED Its occurrence is preceded by faintness, with a feeling of weight at the pit of the stomach, pale- ness of the face, and a feeble pulse. The blood vomited up is dark in color, sometimes coagu- lated and mixed with food, and presents the ap- pearance more or less of coffee grounds. Treatment. — The same as that for bleeding from the lungs. 3. Bleeding from the Nose (Epistaxis). — This may be due to injury to the nose ; it may be an effort of nature to relieve a diseased condition, and if so it is not to be lightly stopped ; or it may be the result of general constitutional dis- turbance. Treatment. — If severe, send at once for med- ical assistance and take care that the doctor is made acquainted with the nature of the case ; in the meanwhile undo all tight clothing round the neck, make the patient sit down on a chair or sofa, with his head slightly thrown back (never allow the patient to hang his head over a basin), open the window, raise the arms stretched to their full extent, well above and behind the head, and keep them in that position, apply a cold wet sponge, or a wet towel, or a lump of ice to the back of the neck between the shoulder blades. HjEMOBRHAGE and its immediate TREAT3IENT 107 also apply cold to the root of the nose ; if the bleeding does not stop, syringe out the nostril from which the blood is flowing with cold water, or with a solution of alum (1 to 2 teaspoonfuls to a pint of water), or with cold tea. Pinch the nose just below the bridge between the thumb and forefinger, or take a piece of soft rag, wrap it up tiglitly and pass it gently into the bleeding nostril. CHAPTER IV WOUNDS AND THEIR IMMEDIATE TREATMENT Wounds— Definition — Kinds and Varieties of — The Immediate Treatment of Wounds in General — The First Field Dress- ing — The Immediate Treatment of Incised, Contused, Punctured and Lacerated Wounds — Poisoned Wounds — The True Poisoned Wound — The Treatment — Insect Stings — Snake and Dog Bites, and their Treatment. Definition. — Wounds may be defined as in- juries to the body with division of the skin and of the underlying parts, more or less. Wounds are of two kinds : — I. Simjjle ; II. Poisoned. I. — Simple Wounds present the following va- rieties : — («) Incised or Clean Cut Wounds. — Wounds with cleanly divided edges and more or less free bleeding, produced by sharp edged instruments. ih) Contused or Bruised Wounds. — Wounds with bruising of the parts and only slight or no external bleeding, produced by blunt instru- ments. 108 rroUNDS AND THEIli IMMEDIATE TREATMENT 109 {c) Ptmctured or Stah WoiiQuls. — Wounds with, as a rule, considerable bleeding and deep internal injuries, produced by sharp pointed in- struments. {d) Lacerated Wounds. — Wounds with ragged edges and very little bleeding, caused by tears, as from machinery in motion, the bites of ani- mals, etc. Bullet wounds generally combine the charac- ters of punctured and lacerated wounds, with, in some cases, injury to the bone. The Immediate Treatment of Wounds in General Here the following points are to be borne in mind : — (I) To arrest the bleeding. (U) To cleanse the wound. (Ill) To keep the wounded parts, if possible, at rest by the application of slings or splints. (lY) To protect the wound from outside dust and dirt by means of some antiseptic (clean) dressing material. (V) To treat constitutional symptoms, if any, such as shock or syncope. Therefore, when a wound has been inflicted, no FIRST AID TO THE INJURED the first thing to do is to avoid touching it with dirty hands or dirty instruments ; there is no justification for introducing more dirt into a wound that may be already dirty. After arresting the bleeding proceed as fol* lows : — If no means are readily available to render the hands and the wound clean, either leave the wound alone or cover it up with some antiseptic dressing, if one can be got at once, till means are at hand to cleanse the wound. As an emergency dressing nothing can be bet- ter than the First Field Dressing used in the British Army. This consists of — An outer cover (sewn cloth) Two safety pins An inside cover (thin waterproof, cemented air-tight) Thin waterproof (mackintosh) folded over dressings (size 12 in. by 6 in., to be torn in half if required) Gauze bandage 4^^ yards long, folded flat into 2^ in. by 4 in. Piece of gauze 17 in. by 13 in., weighing not less than three pennyweights, folded to suit the size of the package WOUiXDS AND THE HI IMMEDIATE TREAT3TENT 111 Compress of cuiu[)ressed charpie (lint) to be of fiax between layers of gauze (like Gam- gee's dressing), capable of being teased out into a thick pad. Minimum weight of charpie 155 grains. Maximum weight 165 grains The antiseptic agent used is corrosive subli- mate 1 in 1000. To Cleanse the W^ound do not attempt to wash it with water procured from any source. Before handling the wound with the fingers wash the hands first with warm water and soap, and tlien rub them with turpentine or rinse them in carbolic solution 1 in 40, then wash the wound thoroughly with an antiseptic solution, such as carbolic acid 1 in 20 to 1 in 40, or perchloride of mercury 1 in 1000 to 1 in 2000. If the above solutions are not at hand or can- not be easily procured, any of the following may be used : — Alcohol, in the form of whiskey or methylated spirits, with an equal bulk of water which has been first well boiled and then allowed to cool. Condifs Fluid, two tablespoonfuls to a pint of warm water. 11-2 FIRST AID TO THE INJURED Coiiimon Salt, a dessert-spoonful dissolved in a tumbler of warm water. In washing the wound be careful not to de- tach any blood clots which may have formed in it, as they prevent further bleeding and exclude impurities. After the wound has been well cleansed of all dirt, in order to keep it clean take a pledget of cotton wool, soak it well in the antiseptic solu- tion which has been used to wash the wound, squeeze it dry and place it over the wound as a temporary protection. To Dress the Wound proceed as follows : — If ready-made antiseptic surgical dressings are at hand use them, if not, place on the wound either — A piece of clean linen which has been well boiled for five minutes and then wrung out, or a piece of lint soaked in carbolic solution 1 in 40, carbolic oil 1 in 10. Over this apply a few layers of clean cotton wool, and then a bandage to keep the dressing in position. To keep the parts at Rest.— First place the edges as near together as possible by strai)pi ng, and then, should the wound be in the upper ex- wo UNDS A ND THEIR IM3fEDTA TE TEE A TMENT 1 1 ". treniity, put the forearm in a large arm sling ; it' the wound happens to be near a joint, appiv" a splint and then put on the sling ; if the lower extremity is wounded apply an outside splint to the limb. Should the wound be in the abdomen or chest, bandage firmly. To treat syncope or shock — {see Chapter YIII, page 193). Special Points in the Immediate Treat- ment OF — I. Incised Wounds. — Arrest the bleeding : then, if necessary, wash and dress the wound as indicated abov^e ; if the edges of the wound gape, adjust them by means of strapping, taking care not to completely cover the wound ; the strap- ping is best applied thus — two strips of strapping long enough to reach well beyond the edges of the wound are taken ; in the centre of one piece a longitudinal slit is cut ; the edges out of the centre of the other piece are cut away, so that this piece can fit into the longitudinal slit ; one piece is now placed on one side of the wound, the other piece on the other side, the middle parts are slipped one into the other and an even pull is made simultaneously on both {see Fig. 62). 114 FIRST AID TO THE INJURED Fig. 62.— Method of Applying Strapping. 2. Contused Wounds.— Apply pressure to the part by means of a pad of cotton wool or linen dipped in one of the antiseptic solutions enumer- ated above if the skin is broken, and fix the pad by a narrow folded triangular bandage, or a figure of 8 roller bandage ; should the skin not be broken, apply to the part a piece of lint which has been soaked in a lotion consisting of spirits of wine one-third, and water two-thirds; and moisten it often. 3. Punctured Wounds. — Arrest the bleeding and wash and dress the wound. 4. Lacerated Wounds. — Wash and dress the wound. Shock usually supervenes after severe lacerations, therefore if present, treat it. II. Poisoned Wounds. These may be — HOUNDS A AD THEIR IMMEDIATE TREATMENT 115 (c() The True Poisoned Wound. — Produced by the introduction of decomposing animal mat- ter or other dirt under the skin. Treatment. — Wash the part immediately with a strong disinfectant. {h) /Stings of Insects. Treatment. — Extract the sting by pressing a small key (a watch key is the best) on to the wounded part, wash the wound with a solution of ammonia, soda or potash, or with an antiseptic solution. A certain amount of shock may sometimes supervene; if so, give stimulants. ( 2 to 4 ozs. in I pint of water, or castor oil, i oz. ; also give stimulants freely and apply warmth to the extremities. Avoid giving pot- ash, soda^ or ammo- nia, or their carbon- ates, but administer frequently chalk and water, magnesia and water, and lime wa- ter, and then give i oz. of castor oil, and stimulants freely. Administer emetics first, then stimulants freely and ad lib., and if necessary by an enema ; make the patient smell the fumes of ammonia, apply the hot and cold douche alter- nately, perform arti- ficial respiration (about 20 to the min- ute), and keep it up steadily, and at the J'Ol^ONS AND THEIR IMMEDIATE TREATMENT 179 Special Poisons. 2. Aconite (Monkshood. Blue Rocket) and its al- kaloids ; occurs in aconite U n i m e n t, neuialine, etc. long intervals, and there may be convul- sions. Their Symptoms. There is warmth the pit of the stomach, tingling of the mouth, lips and tongue, a feeling of constriction in the throat, difficulty in swallowing, numb- ness of the tips of the fingers, loss of sensa- tion, deafness and dimness of sight ; this is followed by paraly- sis, first of th5 lower and then of the upper extremities, the pulse is irregular and al- most imperceptible, the respirations are shallow, feeble and infrequent, there may be convulsions, the pupils are generally dilated, there is great prostration, and death may take place quite suddenly after some slight exertion. Their General Treatment. same time use fric- tion to the extremi- ties. Note. — If life can be maintained (or about half an hour, recovery is almost certain. Give emetics first, then stimulants free- ly, apply warmth to the lower extremities, by hot water bottles and by friction with the warm hand. Ap- ply a mustard poul- tice or a mustard leaf over the heart, keep the patient strictly in the recumbent posi- tion and perform ar- tificial respiration if necessary. Note. — Stimulants may have to be given by an enema. 180 FIRST AID TO THE INJURED Special Poisons. 3. Alcohol, as in rectified, proof, and methylated spirit, brandy, rum, whis- key, gin, etc. 4. The Alkalies, the strong caustic ones, viz. : — (I) Ammonia (Spirits of harts- horn, etc.), as in caustic ammonia, ammonia liniment, compound cam- phor liniment, liquid ammonia. (II) Lime, as caustic lime, quick- lime. (III) Potash, as caustic potash. (IV) Soda, as caustic soda. Their Symptoms. Giddiness, inabil- ity to stand or walk, the gait is tottering, the expression is va- cant, the face is flushed, the conjunc- tivae are congested, the lips are livid, the breath smells of al- cohol, the skin is cov- ered with sweat, the pupils are dilated and fixed but may be contracted, c o n v u 1- sions occur and are followed by stupor and coma. Immediate bu r n- ing pain in the mouth, throat and stomach, vomiting and purging, the mucous membrane of the mouth is des- troyed, and there are symptoms of suffoca- tion and of great shock. Their General Treatment Give emetics; if the patient is insen- sible rouse him and keep him awake, ad- minister hot strong coffee, apply the hot and cold douche al- ternately ; when the patient has sufficient- ly recovered, wrap him up in warm blankets and put him to bed. Caution. — Eviet- ics are not to be give??, but administer vinegar, lemon o r orange juice, tartaric or citric acid in plenty of water ; give demulcents and stmi- ulants if required ; if the power of swallow- ing is lost, give in- halations of acetic acid or vinegar from a pocket handker- chief. POISONS AND THEIR I3I3IEDIATE TEEAT3IENT 181 Special Poisons. 5. Antimony, as chloride or tartar- ated antimony (tartar emetic), occurs also in antimonial wine, and in Hooper's or Hall's specific. 6. Arsenic (Ar- senious acid, White arsenic), may also oc- cur in Aqua Tofania, fly papers, mineral, Vienna and Scheele's emerald green. Fow- ler's solution, Simp- son's rat paste. Roth and Ringeisen's ver- min killer, " Rough on Rats," cheap ice creams, crayons, French chalks, wall papers, and canned fruits (as an impurity of the tin). Their Symptoms. There is a metallic taste in the mouth, with nausea and in- cessant vomiting, a feeling of heat, con- striction and choking in the throat, pain in the stomach, violent purging, and cramps in the limbs, the skin is cold, the head and face are congested, and there is great depression and col- lapse. Faintness and de- pression followed by a burning pain in the stomach, vomiting of brown matter mixed with mucus and streaks of blood, purging, severe cramps in the calves of the legs, constric- tion and dryness of ; the throat, great \ thirst, hiccough, loss of voice, cold sweats, profound shock and exhaustion. Their General Treatment. Encourage vomit- ing by giving large draughts of tepid water, when the vom- iting subsides admin- ister strong tea or coffee, also white of egg mixed in water, barley water, arrow- root or milk. Give stimulants if there is collapse. Wrap the patient up in warm blankets and put hot water bottles to his feet. Give emetics, and then large draughts of tepid greasy or soapy water, or salt and water, dialysed iron in I oz. doses, or magnesia in large quantities, these are to be frequently re- peated ; give olive oil j4 pint in I pint of lime water, adminis- ter demulcents; if there is depression, give stimulants free- ly, and apply warmth and friction ; after the acute symptoms have passed off, apply lin- seed meal poultices to the abdomen. 182 FIRST AID TO THE INJURED Special Poisons. 7. Belladonna (the Deadly Night- shade) and its alka- loid atropine. Their Symptoms. 8. Oantharides (Spanish Fly, Blister Beetle), occurs also in blistering fluid. Heat and dryness of the mouth and throat, suppression of saliva, difficulty of swallowing and great thirst, the face is flushed, the eyes are prominent and spark- ling, the vision is double or indistinct, the pupils are dilated and insensible t o light, there is great excitement and noisy delirium, the gait is unsteady and stagger- ing, there is a fre- quent desire to pass water, with inability to do so, the skin is dry and there may be a rash like that of scarlet fever. Burning sensation in the throat and stomach, with pain and difficulty in swal- lowing, vomiting of mucus and blood, di- arrhoea with blood and slime in the mo- tions, incessant desire to pass water, high temperature, quick pulse, headache, loss of sensibility, and convulsions. Their General Treatment. Give emetics first, then strong hot coffee and stimulants, apply mustard to the calves of the legs and hot water bottles to the feet, administer the hot and cold douclie alternately, and per- form artificial respira- tion. Give emetics and then demulcents, es- pecially white of egg and milk or thick gruel, but avoid giv- ing fats and oils ; when the acute symjv toms have been re- lieved, give the pa- tient a hot bath or apply hot linseed meal poultices to the abdomen. POISONS AND THEIR IMMEDIATE TREATMENT 18c Special Poisons. 9. Camphor, as in the essence, lini- ment and spirits of camphor, and in Ru- bini's solution. 10. Caustic Lu- nar (Nitrate of sil ver). II. Chloral (Chloral hydrate, Syrup of chloral, Hunter's chloral). 12. Chlorine Gas, as in chloride of lime. 13- Chloroform (inhaled). Their Symptoms. Odor of the breath, langour, g i d d i ness, faintness, disturbance of vision, noises in the ears, delirium and convulsions, a cold and clammy skin, weak pulse and diffi- cult breathing. Pain and discolora- tion of the mouth and throat, followed by vomiting of whitish flakey matter which turns black. Deep sleep, with loss of muscular power, diminished sensibility; the face is livid and bloated, the pulse is slow or very weak, the respirations are dirfiinished, and the surface of the body is cold. Irritation of the throat, cough, tight- ness of the chest, difficulty of breath- ing and inability to swallow. The respirations are arrested, the breathing is stertor- Their General Treatment. Give emetics and then stimulants free- ly, apply warmth to the extremities and administer the hot and cold douche al- ternately. Give common salt dissolved in water or milk freely, give emetics (but not sul- phate of zinc), and demulcents. Give emetics, wrap the patient up in warm blankets, and apply hot water bot- tles to the feet, keep the patient roused by shouting or flapping his face with a wet towel, give hot strong coffee, and perform artificial respiration if there is the slight- est failure of the breathing. Admit plenty of fresh air, give inhala- tions of steam or of very dilute ammonia. Pull the tongue forward, see that the mouth and throat are 184 FIRST AID TO THE INJURED Special Poisons. 1 4. Chloroform (swallowed). Their Symptoms. ous, and the face is livid. 15. Copper, i-- j l1ie sulphate (blue vilriol, blue stone), or the acetate (verdi- gris). The breath smells of chloroform, the gait is staggering, this is followed by insensibility, the pu- pils are dilated, the breathing is stertor- ous, the skin is cold, and the pulse is im- perceptible. There is a metallic taste in the mouth, constriction in the throat and gullet, griping and colicky pains in the abdomen, nausea, vomiting and purging, difficult breathing, (juick pulse, great weakness and thirst, cold per- spiration, coldness of the limbs, headache, giddiness, and finally coma. Their General Treatment. clear, loosen every- thing tight about the chest, fla]^ the face and chest with a wet towel, give plenty of fresh air, ajijily the hot and cold douche alternately to the chest and head, and perform artificial res- piration. Give emetics first, then carbonate of soda dissolved in plenty of water, rouse the patient in every possible way, api)ly mustard to the calves of the legs and a mustard leaf over the heart. P'irst give laige quantities of m i 1 k and eggs, then emet- ics (if there is no vomiting), and then large draughts of tepid water, after that barley water, ar- rowroot or gruel, and apply hot linseed meal poultices to the abdomen. rOISONS AND THEIR IMMEDIATE TREATMENT 185 Special Puisons. ;6. Oroton Oil. 17. Ergot of Rye aiul its alkaloitls, er- gulinc, etc. 1 8. Ether (in- haled). 19- Fungi (Fly fungus, poisonous mushrooms). 20. The Gases, viz., carbonic acid or carbonic oxide gas, coal gas or sewer gas, choke damp or after damp, marsh gas, charcoal fumes, and acetylene. Their Symptoms. Great pain in the abdomen, with vom- iting and purging, the face is pale, the fea- tures are pinched, the pulse is small, the skin is moist, and there is great col- lapse. Tingling and cramp of the limbs, dizzi- ness, weakness, itch- ing, vomiting and diarrhoea. Same as chloroform inhaled. There is violent colic, with vomiting and diarrhrea, great excitement and then coma, the pulse is slow, the breathing is stertorous, the pupils are dilated, and the extremities are cold. There is irritation of the throat, witli headaclie,drowsincss, giddiness, and sing- ing in the ears, loss of muscular power, lividity, hurried res- pirations and coma. Their General Treatment. Give emetics first, then demulcents, es- pecially white of egg in milk, and stinm- lants freely, and ap- ply hot linseed meal poultices to the ab- domen. Give emetics first, then castor oil, after that strong tea and stimulants, keep the patient in a recum- bent position, and ap- ply warmth to the extremities. Same as chloroform inhaled. Give emetics first, then castor oil, I oz., then stimulants free- ly, apply warmth to the extremities and hot linseed meal poul- tices to the abdomen. Remove quickly to the fresh air, and per- form artificial respira- tion, ajiply smelling salts to the nostrils, and cold to the head and chest, and give stimulants. 186 FIRST AID TO THE INJURED Special Poisons. Their Symptoms. 21. Holly Ber- ries. 22. HyoBcya- mus (henbane), and its alkaloids hyoscya- mine, etc. 23. Iodine and Iodoform. 24. Laburnum and its active princi- ple cytisine, which is also present in Arnica 25. LEAD as ace- tate (sugar of lead), lead paint or white lead ; may occur in crayons,French chalk and hair dyes. There is vomiting, with pain in the head and abdomen, and purging, the pupilh^ are contracted, then drowsiness followed b y unconsciousness and collapse. Much the same as belladonna, z>.,thirst, dilated pupils, delir- ium, etc. There is pain and heat in the throat and stomach, with vomit- ing and purging (the vomited matter may be yellow or blue), follow ed by giddiness and faintness with convulsive move- ments. There is purging, vomiting, and great restlessness, this is followed by drowsi- ness, insensibility and convulsive twitchings There is dryness of the throat, with a metallic taste and great thirst, colicky pains in the abdomen which are relieved by Their General Treatment. Give emetics, and then stimulants free- ly, apply friction and warmth to the ex- tremities. Give emetics first, then stimulants mod- erately, and apply the hot and cold douche alternately. Give emetics first, then starch and wa- ter, or gruel and wa- ter, or white of eggs and water freely. Give emetics first, then stimulants in moderation, and ad- minister the hot and cold douche alter- nately to the bend and chest. Give emetics free- ly, then Epsom salts {]4 oz. in a tumbk r of warm water), th.en demulcents, and ap- ply hot linseed meal POJiSONS AND THEIR IMMEDIATE TREATMENT 187 Special Poisons. 26. MERCURY, as corrosive sublim- ate, perchloride of mercury, red and white percipitate, red oxide of mercury, and the acid nitrate of mercury. 27. Mussels, also Ptomaines (ani- mal alkaloids, poison- ous meat, poisonous fish). Their Symptoms. pressure, c o n s t ip a- tion, cramps in the legs, cold sweats, pa- ralysis of the lower extremities, and con- vulsions. If corrosive s u b- limate or the acid nitrate is taken, the lips and mouth are white and swollen, the tongue is white and shrivelled, and there is a sense of constriction in the throat ; in all cases of poisoning by mer- cury there is a metal- lic taste in the mouth, pain in the stomach, nausea, vomiting of stringy mucus mixed with blood, profuse purging with bloody stools, a cold and clammy skin, difficult respirations, syncope and convulsions. There is uneasiness and weight at the pit of the stomach, a sen- sation of numbness in the extremities, heat, dryness and constric- tion in the throat, thirst, shivering, dif- ficulty of breathing, cramps in the legs, Their General Treatment. poultices to the abdo- men. First give white of egg mixed with wa- ter or flour and wa- ter, then give emetics freely, after this de- mulcents and stimu- lants. Give emetics first, then castor oil i oz., than stimulants free- ly, apply hot water bottles to the feet, and wrap the patient up in warm blankets. 188 FIRST AID TO THE INJURED Special Poisons. 28. Nitrous Ox- ide Gas (laughing gas). 29. Nitro-Ben= ZOl (nitro-benzine, artificial oil of bitter almonds, essence of henbane). Also pres- ent in aniline dyes, liqueurs, sweetmeats, pomades. 30. NUX VOM- ICA (St. Ignatius Bean), and its alka- loid STRYCH- NIA (as in vermin killers). Their Symptoms. 31. OPIUM (lau- danum), and Us alka- loids (morphine, co- deine, etc.), occur in tincture and wine of opium, Battley's sed- ative solution, Black inflammation of the eyes, colic, vomiting and purging, itching of the skin, failure of the heart's action and collapse Same as chlorofoi m inhaled. There is weakness and discomfort, great nausea and anxiety, confusion of the mind, lividity of the face and body, dilated pupils and convul- sions. Violent rigid con- vulsions, with lock- jaw during the con- vulsive attack ; the eyeballs are promi- nent, the pupils di- lated, the respirations impeded, and the pulse feeble and very rapid. Death usually takes place either from asphyxia or from collapse during a paroxysm. Mental excitement, followed by h e a d- ache, uneasiness, a sensation of weight in the limbs, inca- pacity for exertion, sleepiness,diminution Their General Treatment. Same as chloroform inhaled. Give emetics first, then stimulants free- ly, apply the hot and cold douche alter- nately, and perform artificial respiration. Give emetics first, then animal charcoal ad lib. mixed in wa- ter, followed by an emetic; if possible perform artificial res- piration. Give emetics first, rouse and keep the patient awake in every possible way, by making him walk about, or slapping him with a wet towel, POISONS AND THEIR HI MEDIATE TREATMENT 189 Special Poisons. Drops, Chloiodyne, Dalby's Ccilminative, Godfrey's Cordial and Elixir, Mother's Friend and Soothing Syrup, Nepenthe, Syrup of Poppies, Paregoric and Dover Powder. 32. Paraffin Oil. 33. PHOSPHOR US (as in matches, phosphorus paste, rat poison, vermin killer, Their Symptoms. of sensibility,and con- traction of the pupils ; at first the patient can be roused with difficulty, but later on he becomes quite in- sensible, his muscles are relaxed, his skin is cold, the pupils fail to respond to light, his face and lips are cold and blue, the respirations are slow, irregular, and stertor- ous, and the pulse is weak and compressi- ble. The symptoms vary very much, there may be a burning sensation in the mouth, gullet or stomach, and great thirst ; the extremi- ties are cold, the face is pale, the pulse is feeble, the respira- tions are weak, and often there is coma. Pain in the stom- ach, vomiting, the vomited matter may be luminous in the Their General Treatment. apply ammonia or sal volatile to the nos- trils, give a pint of hot strong coffee, ap- ply the cold douche to the head frequent- ly, perform artificial respiration and keep it up at least for two hours. Do not give wine or brandy. C A u T I o N. — I n making the patient walk about be care- ful not to over-ex- haust him, as with opium poisoning there is always a cer- tain amount of de- pression. Give emetics first, then stimulants free- ly, and apply warmth to the body. Give emetics first, then Epsom salts (^ oz. in a tumbler of water), stimulants if 190 FIRST AID TO THE INJURED Special Poisons. rat paste, Roth & R i n g e i s e n's, with arsenic). 34. Tin and its salts. 35. Tobacco and its alkaloid, nicotine. 36. Turpentine (oil and spirits of turpentine, turps, camphene). 37. Zinc, as sul- phate (white vitriol), and chloride (Bur- Their Symptoms. dark, odor of phos- phorus in the breath, bleeding from the nose, blood stained motions, and convul- sions. The same as in lead poisoning. Nausea and vomit- ing, accompan ied with great weakness and faintness, con- fusion of ideas, dim- ness of sight, weak pulse, cold skin, cov- ered with clammy perspiration, pupils at first contracted and then dilated. Odor in the breath, intoxication, pupils contracted, breathing stertorous, coma, col- lapse and tetanic con- vulsions, irritability of the bladder, the urine having the smell of violets. The symptoms of turpen- tine poisoning resem- ble somewhat those of opium. Corrosion of the lips and of the mu- cous membrane of the Their General Treatment- required, and demul- cents, especially milk. Avoid giving fats and oils. Give emetics first, then sal volatile in water, and white of egg in milk. Give emetics first, then strong tea, and stimulants freely, ap- ply warmth to the extremities and keep the patient in a re- cumbent position. Give emetics first, then Epsom salts ( i oz. in a half a tumbler of warm water), and demulcents. Do not give emetics but give first large draughts of milk and FOJSONS AND THEIR IMMEDIATE TREATMENT 191 Special Poisons. 1 e t t's Disinfecting i'luid^. Their Symptoms. mouth, pain and in- cessant vomiting, the pulse and respira- tions are quickened, the pupils are dilated, the muscles are par- alyzed, and coma supervenes. Their General Treatment. white of egg, and then bicarbonate of soda or common soda in large quantities dis- solved in warm wa- ter, and ihen strong tea, apply linseed meal poultices to the abdomen. Note. — The following Poisons are frequently taken either acci- dentally or for suicidal purposes, viz. : Carbolic acid, Oxalic acid, Prussic acid, Arsenic, Opium, Phosphorus, Strychnia (Nux vomica), Lead (Sugar of) and Mercury (Red and White Precipitate), In the foregoing table these are printed in heavy capitals. CHAPTEK yill THE IMMEDIATE TKEATMENT OF INSENSIBILITY AND FITS Insensibility, its causes— Fits, kinds of— The Causes, Symp- toms and Treatment of Syncope, Shock, Concussion and Compression of the Brain. Apoplexy, Alcoholic Intoxica- tion, Sunstroke and Freezing — Test for Insensibility — How to act if a patient is found in a state of Unconsciousness — The Symptoms and Treatment of Epileptic Fits, Hysterical Fits and the Convulsions of Infants. INSENSIBILITY Loss of consciousness may be produced by the following causes : — 1. Syncope, or fainting. 2. Asphyxia, or suffocation. 3. Shock and collapse. 4. Concussion of the brain. 5. Compression of the brain. 6. Apoplexy. 7. Alcoholic intoxication. 8. Narcotic poisoning, as opium poisoning. 192 ni MEDIA TE TREA TMENT OF INSENSIBILITY 1 9:5 9. (Sunstroke. 10. Freezing. Unconsciousness is also present in the follow- ing :— 1. Epilepsy. 2. The convulsions of infants. 3. Uraemic poisoning, which often comes on in the course of kidney disease and is due to the non-excretion (by the kidneys) of the waste ma- terial in the blood. But as convulsions form the most prominent symptom, these diseases are dealt with separately under '' Fits." I. Syncope, or Fainting, may be due to men- tal emotion, pain, extreme exhaustion (as from hunger, fatigue, etc.), haemorrhage, cold, heat (particularly if combined with a close atmos- phere, as in heated rooms, in large crowds, etc.), constriction of the chest (as in tight lacing, etc.), and organic disease of the heart. Symjjtoms. — Fainting is generally ushered in by a feeling of giddiness and fluttering at the heart. This is followed by the face becoming suddenly pale and the lips white ; the pulse be- comes weakened and the breathing quickened ; a cold sweat appears on the brow^ and the palms 194 FIRST AID TO THE INJURED of the hands ; the patient staggers and finally falls to the ground in an unconscious state. Rarely convulsive movements of the whole body may also be present. Treatment. — As fainting is caused by a dim- inution of the supply of blood to the brain from partial paralysis of the heart, the object to be aimed at in treatment is to restore the cerebral circulation ; therefore, when a person has fainted, do not attempt to place him in a sitting or stand- ing posture (as this will only embarrass the al- ready weakened action of the heart, and may be fatal), but lay him flat on his back, or, better still, on his left side with his pelvis and feet slightly raised ; loosen all tight clothing about his body and neck ; give him plenty of fresh air ; sprinkle cold water on his face ; apply smelling salts to his nostrils ; when able to swallow, give him a glass of water or a little brandy, whiskey, or sal volatile mixed in water, and keep him in the recumbent position for some time after he has recovered. If the faint is prolonged and consciousness does not return, send for medical assistance, but in the meanwhile apply warmth to the feet and a hot mustard plaster over the region of the heart, and if natural breathing has IMMEDIATE TREATMENT OF INSENSIBILITY 195 not returned, perforin artificial respiration by the " Sylvester '• method. In a crowded room a fainting fit may be pre- vented by placing the patient in a stooping posi- tion on a chair and bending his head between his knees. The person must be held, for if he faints in this position he dives forward on to his head, and may turn a somersault or might break his neck. If the patient has completely fainted this treatment is not to be attempted, as it only helps to obstruct the circulation and respiration. 2. Asphyxia. — This has been dealt with in Chapter lY. 3. Shock, or Collapse, may be produced by severe injuries or emotional disturbance, causing a profound depressing effect upon the central nervous system. The injuries most liable to produce shock are : — (I) Those involving large surfaces of the skin, as in burns and scalds. (II) Those causing crushing or tearing of the body, as machinery and railway accidents. (III) Those affecting the abdomen and viscera. Loss of blood and exposure to cold intensify the condition of shock. 190 FIRST AID TO THE INJURED Symptorns. — A person in a state of shock pre- sents the following appearance : He lies flat on his back, his limbs are flaccid, and he makes no spontaneous movements ; his body is cold and clammy, his face is pale, his eyes are sunken, his pulse is small, feeble and irregular, his respira- tions are shallow, feeble and sighing, his temper- ature falls to 97° F. or a degree or two lower, and he is semi-unconscious. Should a case of shock tend to terminate fa- vorably, the condition known as that of " Reac- tion " comes on. This is usually ushered in by the patient vomiting, the pulse then becomes stronger, the body warmer, and color returns to the face. Treatment. — The object to be aimed at in treatment is to bring about reaction by the appli- cation of warmth and the administration of stim- ulants. Therefore, to treat shock place the pa- tient in bed between blankets as soon as possible, keeping his head quite low. Apply hot water bottles to his feet and between his thighs, and apply friction to his arms and legs. If able to swallow, give him small quantities of hot stimulants, and frequently repeat them till reaction takes place, then lessen the stimu' IMMEDIATE TEEATMENT OF INSENSIBILITY 197 lants considerably, taking care not to over stimu- late. During the state of collapse, should, the breath- ing become embarrassed, perform artificial res- piration according to the " Sylvester " method. 4. Concussion of the Brain is caused usually by blows or falls upon the head, or falls upon the feet or lower end of the spine, the effect being a severe shaking up of the brain substance. /Symptoms. — These var}^ in their severity ac- cording to the force of the blow applied. The patient may present the appearance of being merely stunned, or he may be in a condition identical with that already described under " Shock." Treatment. — The same as for shock ; and at the same time apply cold in the form of ice or wet cloths to the head. Avoid alcoholic stimu- lants, but give instead hot beef tea or hot coffee, and keep the patient absolutely quiet in a dark- ened room. 5. Compression of the Brain is caused by in- juries to the head producing pressure of the brain substance either by the depression of a piece of bone on to it, or by a blood clot (produced by the rupture of a blood-vessel). 198 FIRST AID TO THE INJURED Symptoms. — Kesemble those of apoplexy, which see. Treatment. — If there is a wound on the head, dress it; otherwise adopt the same treatment as for apoplexy. 6. Apoplexy is caused by the bursting of a diseased blood-vessel into the substance of or upon the surface of the brain, causing compression of that organ. It usually occurs in elderly persons. Sy77iptoms. — Just before the attack there are generally some premonitory symptoms, such as headache, giddiness especially on stooping, weight and fulness in the head, noises in the ears. When the actual attack occurs, the patient is more or less unconscious, his face is flushed, his breathing is shallow and stertorous ; his eyes are insensible to light and touch, the pupils are fixed, and are either unequally dilated, or one or both may be contracted ; his pulse is full and slow, and there is paralysis more or less affecting one side of the body. Treatment. — The object of treatment is to get the circulation quiet and the heart's action free from embarrassment ; therefore loosen all tight clothing about the neck and chest, put the patient to bed with his head raised, and apply cold to it ; IMMEDIATE TREAT3IENT OF INSENSIBILITY 199 apply hot water bottles to his feet and mustard poultices to the calves of his legs. Be careful to give nothing by the mouth (as it may choke the patient), and send for medical assistance. 7. Alcoholic Intoxication : — Symptoms. — A person in a state of stupor from alcohol presents the following picture : He is semi-unconscious, and can be partially roused, his face is flushed and bloated, his eyes are reddened and bloodshot but are not insensible to touch, his pupils are equally dilated and fixed, his lips are livid, his breathing is slow, the surface of his body is cold, and he may smell of liquor. ]}^ote. — Alcoholic stupor may be hard to dis- tinguish from apoplexy, but the state of the pupils, the sensitiveness of the eyes to touch, and the presence or absence of paralysis will help to determine the condition. Treatment.— (See "Poisons," Chapter VII, page 180.) Caution. — If in doubt as to whether a person is suff'ering from drunkenness or apoplexy, treat him for the latter and be particularly careful not to make him vomit. 8. Narcotic Poisoning. — (See " Opium Poison ing," Chapter VII, page 188.) 200 FIRST AID TO THE INJURED 9. Sunstroke is caused by exposure to the rays of the sun. Symj^toms. — Sunstroke is ushered in with gid- diness, nausea and weakness; this is followed by drowsiness and more or less unconsciousness. The eyes are bloodshot, the skin is hot and dry, the breathing is quick and noisy ; the pupils are contracted at first and become dilated afterward ; the pulse may be slow or quick, and there may be convulsions. Treatment. — Place the patient in a cool, shady spot ; remove the clothing from the neck and upper part of the body and raise the head ; douche the head, neck, chest, and spine with cold water, or wrap cold sheets round him, and con- tinue these cold applications till he becomes con- scious, then remove him to bed, keep the room darkened, and watch him carefully ; if the un- consciousness returns, renew the application of cold. 10. Freezing : — Treatment. — Take the patient into a room which has no fire in it, rub the body with ice-cold or snow water and restore warmth gradually. It is dangerous to apply heat too early ; as soon IMMEDIATE TEEAT3IENT OF INSENSIBILITY 201 as the patient is able to swallow give him stimu- lants and hot drinks. Test for Insensibility. — To determine whether a person is insensible, raise the eyelid and touch the white of the eye, blinking, which cannot be avoided, if the person is conscious, does not occur. How to act if a Patient is found in a State of Unconsciousness. — Before efficient help can be rendered, the first thing to do, is to try and arrive at the cause which has produced the state of un- consciousness, and in order to do this a sys- tematic examination of the patient and his sur- roundings must be made, therefore proceed as follows : — (I) Notice the position of the body and its surroundings. (U) Notice whether the body is lying still or there are convulsive movements. (Ill) If possible obtain all information as to the cause. (lY) Lay the patient on the back, inclining the head to one side (to prevent the tongue from falling back or vomited matter going down the trachea) ; if the face is flushed slightly raise the head, if the face is pale keep the head flat, place the arms by the sides and extend the legs, and ^02 FIK^T AID TO THE INJURED loosen all tight clothing about the neck and chest. (Y) Examine the head, to ascertain whether there is a depressed wound (which would suggest compression), or a mere bruising (which would suggest stunning). (VI) Examine the eyes to see if the}^ are sen- sitive to light and touch, if there is any squint- ing, and the state of the pupils ; {ci) If sensitive to touch, no brain injuries are present. {h) If the pupils are unequally contracted, there is brain trouble. (c) If the pupils are equally contracted, there is opium poisoning. (YII) Examine the face ; {a) If it is drawn to one side, this will indicate apoplexy or compression of the brain. ih) If it is bloated and flushed, this will sug- gest the excessive use of alcohoL (VIII) Smell the breath ; the odor of opium or alcohol may be detected. (IX) Examine the mouth and tongue ; froth in the mouth and a tongue that has been bitten will indicate fits, particularly epileptic. (X) Notice the breathing ; IMMEDIATE TREATMENT OF INSENSIBILITY 203 {a) If it is slow, it indicates great weakness as in shock. (h) If it is snoring (stertorous), it indicates brain trouble. (XI) Examine the pulse ; {a) If it is slow, there is brain trouble. (p) If it is rapid, there is sunstroke or fever. {c) If it is quick and thready, there is great weakness — such as shock. (XII) Feel the surface of the body ; («) If the skin is abnormally cold, there is either freezing, intoxication, collapse, or faint- ing. ih) If the skin is hot, there is sunstroke or high fever. (XIII) Examine the ribs, collar bones and limbs for fractures. (XIY) Examine the limbs to see if there is any paralysis; this is done by raising the limbs and allowing them to fall, if they do so lifelessly it suggests paralysis. (XY) If convulsive movements are present, the patient is subject to fits of some kind (either epileptic, hysterical or ursemic in an adult, or convulsions of infants). 204 FIRST AID TO THE INJURED FITS I. Epileptic Fits. — The distinguishing features of these fits are convulsive movements and un- consciousness. An epileptic fit begins by the pa- tient suddenly falling unconscious, with strained and rigid muscles ; as he is seized he may utter a sharp shrill cry or yell. This stage of rigidity is then succeeded by a stage of convulsions in which the patient's body is thrown into violent tvvitchings and contortions with foaming at the mouth. During this stage the tongue may be bitten. After the patient has been in the con- vulsive stage for a few minutes, he ma}^ at once regain his consciousness or he may be more or less confused for a time, or more frequently he becomes drow^sy and passes into a deep sleep or stupor, which may last several hours. Treatment. — During the convulsive stage place the patient in a safe place to prevent him from hurting himself ; put a piece of wood or other hard substance well padded between his teeth to prevent him from biting his tongue, loosen all tight clothing about the neck, chest and abdomen, and do not attem})t to restrain the convulsive movements or to administer anything by the mouth. nr 31 EDI ATE TREATMENT OF FITS 205 After the convulsive stage has passed off and the patient seems drowsy, encourage natural sleep. If on waking he seems exhausted, give him a little soup or beef tea, but do not give stimulants. 2. Hysterical Fits.— These occur more often in females than males and are ushered in with crying, sobbing or laughing without any cause ; then follow jerky movements of the limbs (not truly convulsions), at the same time the breath- ing is quickened, the eyelids are closed, and in severe attacks the patient falls down apparently but not actually unconscious, taking care never to hurt herself. Treatment.— The best treatment for hyster- ical patients is to exclude all fussy friends and let them alone. The patient will come to her- self when she realizes that her condition is excit- ing no sympathy or alarm. 3. The Convulsions of Infants. — These are usually caused by teething, constipation, indiges- tion, worms, etc., but they may be due to fever or brain disease. Symptoms. — Just before the occurrence of a fit the child is usually peevish and fretful. Dur ing the fit the body first becomes stiff, the pulse 206 FIRST AID TO THE INJURED is rapid and weak, the breathing is hurried, the skin is wet with a cold, clammy perspiration, and there is complete loss of consciousness. The rigidity of the body lasts a few seconds, and is succeeded by a stage of convulsive movements in which the muscles of the face twitch and the limbs jerk violently. As one fit passes off an- other may supervene, or the child may pass into a semi-comatose condition and then into a natu- ral sound sleep. Treatment. — The course to adopt is to re- lieve as quickly as possible the cerebral circula- tion, therefore place the child at once in a bath as warm as can be borne comfortably from ten to twenty minutes, or put the feet in hot water with mustard in it ; at the same time apply cold sponges to the head and quickly change them, and send for medical assfstance. 4. Uraemic Convulsions. — In the course of Bright's disease convulsions and unconsciousness may occur. Treatment. — The course to adopt here is to encourage the action of the skin, therefore place the patient in bed between warm blankets, pack hot water bottles round him, and send for med- ical assistance. CHAPTER IX burns and scalds and their immediate treatment; electric shock and its im- mediate treatment; the removal of foreign bodies from the eye, ear, and NOSE Burns, degrees and treatment of —Burns from Acids and Alka- lies, their treatment — To Extinguish the Flames from Burning Clothing — Shock by Electricity, the treatment of — Removal of Foreign Bodies from the Eye, Ear and Nose. BURNS AND SCALDS Burns are caused by the application of a fire or dry heat. Scalds are caused by the application of hot liquids or moist heat. Burns are divided into the following degrees, according to the extent of injury inflicted, viz. : — 1st degree. — A mere reddening of the skin. 2d degree. — The formation of blisters. 207 20H . FIRST AID TO TEE INJURED 3(1 degree. — Charring and the destruction of tissues. In addition to the actual damage caused by burns and scalds there is also present : — (I) Shock to the System. — This is in direct proportion to the superficial extent of the burn. Burns of the abdomen and chest are especially liable to produce marked shock, and in children suffering from burns and scalds the shock is usually profound. (II) Congestion of Internal Organs. — This usually comes on after the shock. Treatment.— In the management of burns and scalds the following points have to be borne in mind : — {a) The local injury. (J) The shock to the system. If the shock is severe it should be treated first, and the local injury afterward, when reaction has set in. The Local Injury. — In attending to a burn care should be taken that the clothing is removed with the utmost care from the burnt part, and that no blisters are broken in removing it. The clothing should therefore be cut off, and if parts adhere to the body they should be gently re- nUENS AND SCALDS 209 moved after first soaking them in oil ; if this is not sufficient, the part should first be immersed in a bath of warm water. If the burns are ex- tensive only one portion of the body should be dressed at a time, the rest being kept covered up. To dress the Bicrns proceed as follows : Either apply over the burnt parts pieces of lint which have been soaked in carron oil (a mixture con- sisting of equal parts of linseed oil and lime- water), or in -carbolic oil, 1 in 40, or in a saturated solution of common washing soda, or spread boracic acid ointment (which has been diluted with an equal part of vaseline) upon pieces of lint and apply it to the burnt parts. J^ote. — Strong antiseptics for dressing burns should be avoided, and the dressings should not be changed too often. Burns from Acids. — First drench the parts with water, wash them with a solution made by dis- solving washing soda in water, and then treat as for an ordinary burn. Burns from Alkalies. — Drench the parts first with water, then \vash with a solution of dilute vinegar and water, and finally treat as for an ordinary burn. To Extinguish the Flames from Burning Cloth- 210 FIRST AID TO THE INJURED ing. — Throw the person clown whose clothes are on lire, and cover him up as quickly as possible with a rug, coat, shawl, blanket or other article of covering. SHOCK BY ELECTRICITY This may be produced by : — (I) Natural Electricity. — As lightning. (II) Artificial Electricity. — As currents from telegraph, telephone, electric lighting and motor wires. Natural Electricity. — The effects of lightning vary according to circumstances ; there may be only slight shock with dizziness, or there may be violent convulsions, insensibility or immediate death. Artificial Electricity. — The danger of a current of electricity is in proportion to its intensity — thus, the low tension currents of the telephone and telegraph wires would probably only produce slight shock, while the high tension currents (and especially the alternating ones), for lighting and motor purposes are extremely dangerous. The current from a dynamo may be 10,000 volts, for arc lamps the current is usually 2,400 volts, and for lighting (in houses) 100 volts. SHOCK BY ELECTRICITY 211 A current of 100 volts would be very danger- ous, a current of from 20 to 30 volts is as much as can be comfortably borne by a strong man. When electric wires have a current passing through them, they are termed live wires, and it is from these that there is danger, as they may be exposed either by accident or for repairs. Symptoms. — A person taking hold of naked live wires {i. e., those that are not covered with an insulating material), wnth a current of high tension passing through them, would most likely be violently convulsed and be unable to let go, or there might be insensibility with suspended animation or even death. Parts of the body or clothes in contact with the wires may be scorched or burnt. Treatment. — Here proceed as follows : — (I) Kemove the sufferer from the source of danger; this must be done with the greatest care, or the person giving assistance may himself receive the shock and be rendered incapable. " When the injured person retains his hold of the wire, it is dangerous to touch any part of him, even the parts of the body covered by clothes." A case of this kind is recorded in the Electrical Review — " While a man was cleaning 2i2 FIRST AID TO THE INJURED an electric street lamp in Boston, he received a shock and was killed, his body being suspended from the wires ; a man who endeavored to re- move the body came in contact with the current and was dashed to the ground with such violence that he died shortly afterward." Therefore before removing the sufferer, first protect the hands whenever possible with india- rubber gloves (these are used in electrical works and ma}^ be at hand), if these cannot be procured, first wrap a mackintosh coat or a thick dry woolen cloth coat, or other dry article of cloth- ing round the patient (damp articles of clothing are good conductors of electricity, and the suffer- er's own clothes may be damp from perspiration), and then pull the sufferer away from the source of danger. (II) Send at once for medical assistance, but in the meanwhile place the patient in a comfort- able position, loosen all tight clothing round the body, and if there is any difficulty with the breathing begin at once to perform artificial respiration. Two live naked wires of which the sufferer may have hold, may be short circuited by drop- ping (not placing, as then the assistant might get REMOVAL OF FOREIGN BODIES 213 the shock), an iron bar or other metallic tool across them, in this way carrying the current from one wire to the other instead of through the body of the sufferer. REMOVAL OF FOREIGN BODIES 1. From the Eye — Foreign bodies may be removed from the surface of the eye as follows. If under the upper lid, first evert the lid by placing a bodkin or match over it, and then gently pull the lid over ; in this way the whole of the upper surface of the conjunctiva is exposed and may be very gently swept over with a camel's hair brush, or with a piece of soft linen dipped in warm water. If under lower lid, the whole of the conjunctiva under the lower lid may be exposed by gently pulling the eyelid down with a finger, and the foreign body removed as described above. 2. From the Ear.— Great care should be taken in these cases not to poke any sharp instruments into the ear, as the drum might easily be in- jured ; warm glycerine or oil may be poured into the ear and the organ gently syringed out with warm soapy water. 214 FTBST aid to the INJURED 3. From the Nose — The nose should eithei be blown forcibly, or gently syringed out with warm water, or the patient may be made to snitl pepper and sneeze. CHAPTER X PREPARATION FOR THE RECEPTION OF A CASE OF ACCIDENT OR SUDDEN ILLNESS Selection and Preparation of the Room— The Bedstead and Bed — How to put on a Draw-sheet — Fracture Bed— Carry- ing the Patient up-stairs to his Room— Removing the Clothes — Lifting the patient into bed — Preparation for the Surgeon's visit. While engaged in attending to a case of acci- dent or sudden illness, if possible, send a mes- senger to the patient's house, in order that arrangements may be made for his reception. I. Selection and Preparation of the Room. (I) Selection of the Room. — The points to attend to — as far as possible — are : that the room should be easily accessible, it should be large and lofty with a south or southwest aspect, the win- dows should admit sufficient light, and should be made to open top and bottom, and there should be a fire-place with a chimney that does not smoke. (II) Preparation of the Roo7n. — The room 215 216 FIRST AID TO THE INJURED should be thoroughly cleansed (if time will per- mit of it), well ventilated by drawing down the top windows, a tire should be lighted in it, it should be warmed to a temperature of 60° Fahr. and maintained at this, a thermometer being hung in the room for the purpose of regulating the temperature ; the carpet and all superfluous furniture should be removed from the room. 2. The Bedstead and Bed. (I) The Bedstead. — Wide bedsteads are to be avoided, as the patient cannot be easily got at; the best kind of bedstead to use is an iron one, 3 to 3^ feet wide b}^ 6^ feet long, it should be placed away from the wall (so that it can be approached from either side), and if possible across the room between the door and fireplace with the head facing the window. (II) The Bed. — Feather beds and flock mat- tresses are to be avoided ; hair mattresses are the best; the bed clothes should be light and warm, no vallances or curtains should be used, and care should be taken that the space under the bed- stead is vacant. The bed should be made and the bed clothes well turned down, two stout chairs should be placed next to the bed, on which to rest the PREPARATION 217 stretcher while the patient is being undressed. It may (in cases where the injuries are severe, or mud-stained clothes have to be removed or ex- tensive dressings applied), be necessary to have a second bed or couch in the room on which to first lay the patient. Extra blankets and hot w^ater bottles should be kept in readiness. In cases of collapse the blankets should be made hot and flannel should be wrapped round the hot water bottles. If there is any likelihood of the bed clothes being soiled, i. e., in cases of extensive injury, or w^here dressings have to be applied, or where the patient is unconscious or extremely weak and passes his evacuations under him, a draw-sheet should be placed on the bed. To put on a Draw-Sheet — proceed as follows : — Procure a large cotton sheet, fold it length- ways into four and place it across the bed so that it will reach from just below the patient's shoulders to his knees, now place a piece of oil- cloth or other waterproof cloth between the draw-sheet and the under sheet, the draw-sheet being about four inches wider than the oilcloth; one end of the draw-sheet is tucked in under the mattress, the other end is rolled up on the oppo- 218 FIRST AID TO THE INJURED site side of tlie bed ; when the part of the draw- sheet under the patient becomes soiled it is withdrawn a little to one side by being rolled up a little more. In cases of fracture where the patient will have to lie in bed for several weeks, it is im- portant to have a properly arranged bed — termed a " fracture bed." The Essentials of a " Fracture Bed " are : (I) That there should be no sagging or giving way ; (II) That the surface should be evenly smooth and comfortably elastic ; (III) That the foot of the mattress should be a little higher than the head. The best way to arrange a fracture bed is as follows : first place a straw mattress on the bed- stead, then on the mattress place two horsehair mattresses 3^ to 4 inches thick, and on the top mattress one blanket ; to raise the bedstead place a thin board under the legs at the foot. In fracture of the lower extremity or of the spine, there should be no bolsters or pillows for the head, but only a thin cushion, and boards should be placed across the bed under the mat- tress. PREPARATION 219 A cradle to take off the weight of the bed clothes may be necessary in fracture of the lower extremity, or sprain of the ankle joint ; for a cradle, a cardboard box with the ends cut out, or a three-legged stool, may be used. 3. Carrying the Patient Upstairs to His Room. — Before removing the patient to his room, the hall and staircase should be so far cleared as to allow sufficient room for those carrying him to pass. The particular method to be adopted for carry- ing will depend in each case upon the nature and extent of the injury, and the condition of the patient. A patient may be carried up-stairs — (I) On a stretcher. Here the head should go first, and the two bearers at the foot should take care to keep the stretcher as nearly hori- zontal as possible by raising it, or (II) By placing the patient in a strong chair and carrying him up backwards, while a third person walks after the chair, helps to support it, and prevents the patient from falling out. 4. Removing the Clothes.— Before putting the patient to bed the clothes should be first removed, and great care should be taken in doing this ; in 220 FIEIST AID TO THE INJURED serious cases it is better to remove the clothes by cutting thein away. In removing a coat irom an injured arm, draw out the uninjured arm first, and in putting on anything put the injured arm in first. In removing trousers from an injured limb rip up the outside seam. In removing clothing in cases of burns and scalds, cut away the parts which are not adher- ing, and soak the adhering parts well with oil before removing them. 5. Lifting the Patient into Bed.— This may be done as follows : — (I) If the bed is narrow and there is room for the stretcher, place it on the floor with the head close to the foot of the bed, three bearers can then .lift the patient, head foremost, over the foot of the bed. (II) If the bed is wide, place the stretcher close alongside the bed, the patient's head cor- responding to that of the bed, Nos. 1, 2 and 3 bearers place themselves on the far side of the stretcher, and No. 4 bearer on the near side ; the patient is then lifted, and supported on the knees of Nos. 1, 2 and 3 bearers. No. 4 bearer pulls awav the stretcher and stands aside, while the PREPARATION 221 Other bearers lift the patient, stand up, and place him in position on the bed. 6. Preparation for the Surgeon's Visit. — When summoning a doctor, inform him as far as possi- ble of the nature of the case so that he may come prepared. The following should be in readiness : — Plenty of hot and cold water, clean towels and soap, and a receptacle for dirty water. Fo7' Burns and Scalds. — A good supply of clean old linen, cotton wool, olive oil, "carron " Dil and bandages. i^6>/' Ilcemorrhage. — Ice, sponges and plenty of water. J^or Drowning. — Plenty of blankets heated before the fire and several hot water bottles, the sheets from the bed should also be removed. If poultices and fomentations are required, plenty of boiling water; linseed meal, mustard, a small basin, a large spoon, olive oil, tow, flannel, a kitchen roller and two sticks or a large towel. Ind ex A BDOMKN, bandage for 26, 66 Acetylene poisoning . . 185 Acids acetic poisoning, etc. 177 arsenious poisoning . . 181 carbolic poisoning . 178 carl)onic poisoning . . 185 glacial acetic poisoning 177 hydrochloric poisoning 177 hydrocyanic poisoning 178 muriatic poisoning . . 177 nitric poisoning . . . 177 oxalic poisoning . . 178 poisoning from . . . 177 prussic poisoning . . , 178 sulphuric poisoning . . 177 Aconite poisoning ... 179 Alcohol poisoning . . . 180 for wounds Ill 199 180 180 180 180 180 178 188 181 181 Alcoholic intoxication . Alkalies, ammonia caustic poisoning liniment poisoning lime poisoning . . potash poisoning . soda poisoning . . Almond Flavor poisoning Aniline dyes poisoning . Antimonial wine poison- ing .... Antimony poisoning . . chloride of, poisoning 181 tartarated poisoning . 181 Aperients in poisoning . 176 castor oil as 176 sulphate of magnesia as 176 Apoplexy 198 Aqua fortis poisoning . . 177 Arnica poisoning ... 186 Aromatic vinegar poison- ing .... 177 Arsenic, white poisoning 181 Artery, axillary .... 84 brachial 85 common carotid ... 83 facial 83 femoral 86 occipital 83 popliteal 87 posterior tibial .... 88 anterior tibial . . . 88 radial 85 subclavian .... 84 temporal 82 ulnar 85 Artificial respiration 98, 157 Hall's method . 157, 161 Howard's method . 157, 160 Sylvester's method . 157 Asphyxia from blocking larynx ... 169 223 224 INDEX choking 169 drowning 165 hanging 17u poisonous gases . . . 170 strangulation .... 170 Atropine poisoning . 182 Axillary artery .... 84 Back, bandage for wound 25 Back of head, bandage for 22 Bandages 11 capeline 60 elastic 41 for fixing splints . . 38 kinds of 11 knotted 63 looped triangular . . 39 names of part of . . . 42 non-elastic 41 roller . . . . 40 application of . , . 42 circular 44 figure of 8 46 for abdomen .... 66 arm 56 breast 52 chest 65 elbow 55 finger 58 foot 59 groin 48 hand 56 head ..... 60 heel 53 hip 48 knee 55 leg 59 shoulder .... 50 many-tailed .... 72 oblique 46 reverse spiral ... 45 Bandages (con ti nued ) simple spiral .sizes of . . . spica for breast elbow . . . groin and hip heel . . knee . . shoulder thumb . table of . . twisted . . semi-elastic . special . . . four-tailed many-tailed square . . T .... Squire's method hand to fasten . . fold . . . roll . . . triangular . . for abdomen for 45 41 52 55 48 53 55 50 53 66 63 41 69 69 72 69 73 arm back back of head .... chest elbow . for elbow, fracture of eye for femur fist . . 32 16 15 42 12, 15 26, 35 . 26 25 22 25 27 143 . . . . 22 fracture of 148 31 for folding, for storage 13 broad and narrow 15 foot 33 fracture of hand 146 forehead .... 22 fractures .... 37 groin 37 INDEX 225 Bandages (continued) haemorrhage ... 40 hand 28, 31 head 22 hip ...... 33 humerus, fracture of 141 jaw, fracture of . 129 leg, fracture of . . 155 lower jaw .... 129 palm 30 patella, fracture of 153 pelvis, fracture of 134 "reef" 16 ribs, fracture of . 132 shoulder .... 24 sling, large for fore- arm .... 17 elbow 17 small 25 stump 37 temple 22 tourniquet ... 94 wounds 20 narrow fold .... 92 uses of 11 Base of skull, fracture of 328 Battley's solution poison- ing 188 Bed, for accidents . . . 216 Bed-fracture, essentials of 218 Bedstead for accidents . 216 Belladonna poisoning . . 182 Bites by mad dogs . . . 116 snakes 115 Bitter almonds poisoning 178 Black drops poisoning . 188 Bleeding from the nose 103, 106 Blister Beetle poisoning 182 fluid poisoning ... 182 Blood spitting 103 Blue rocket poisoning . 179 stone poisoning ... 184 vitriol poisoning . . . 184 Brachial artery .... 85 Breast, bandage for female 52 Breathing, to restore from drowning . . 165 Burnett's fluid poisoning 190 Burning clothing, to ex- tinguish flames of 209 Burns and scalds . . 20"^ 221 from acids 209 alkalies 209 Camphene poisoning . 190 Camphor essence poison- ing 183 Liniment poisoning . 180 spirit poisoning ... 183 Cantharides poisoning . 182 carotid artery .... 83 Capeline bandage ... 60 Carbolic acid poisoning . 178 Carbonic poisoning ... 185 oxide gas poisoning . 185 Carrying and lifting pa- tients .... 220 patients 219 Caustic, lunar, poisoning 183 Cleansing wounds . . . Ill Collar bone, fracture of . 135 Colles fracture 146 Compound fracture, im- mediate treat- ment of . . . 127 of tibia 120 Compression of axillary artery ... 85 by forced flexion . 89 226 INDEX brachial artery . . . 85 Demulcents in poisoning 177 by forced flexion 89 Digital compression of brain 197 haemorrhage . 81 carotid artery . . . 83 Dislocations 118 common femoral ar- Dover's powder poisoning 188 tery .... 86 Draw sheet, to put on 217 facial artery . . 83 Drowning, treatment of occipital artery . . . 83 apparent death popliteal artery by from , . 104 forced flexion 93 what things to prepare radial and ulnar ar- in case of . . 221 teries . . 85 subclavian artery . 84 Ears, removal of foreign superficial femoral bodies from . 213 artery . . . 89 bandage for 22 temporal artery 82 Elbow, iDandage for . . '^^ ^ '5 Concussion of the brain . 197 joint, fracture of . . . 143 Condy's fluid for wounds 111 Electricity 210 Constitutional symptoms, Emetics, caution as to . 175 treatment of . 97 for use in case of poi- Constriction of whole limb 92 soning . 175 Convulsions 205 Epileptic fits 204 of infants .... 205 Epistaxis . . ... 1(6 urfemic 206 Ergot of rye poisoning . 185 Co])[)er acetate poisoning 184 Ergotine poisoning . . . 185 sulphate poisoning . . 184 Esmarch's elastic tube . 92 Corrosive poisons . . . 172 tourniquet \-Q sublimate poisoning 187 Ether poisoning .... 185 Cranium, fracture of . . 27 Expiration, how to i)ro- Crayons, poisonous . 181. 186 duce .... 159 Cyanide of potassium poi- Eyes. l)andage for wounds soning . . . 178 of 22 Cytisine poisoning . . 186 removal of foreign bodies from . 213 Daley's c a 1 m i n a t i v e poisoning . . 188 Face, bandage for side of 22 Deadly nightshade poison- Facial artery 83 ing . ... 182 Fainting 193 Death, appearances accom- Female breast, bandage panying in as- for 52 phyxia . . . 170 Femoral artery .... 86 INDEX 007 iVinur, fracture of . . 147 subclavian artery 84 Field and screw tourni- temporal artery . . 82 quets .... 97 tibial artery .... 88 Finder l)andage .... 58 ulnar arteiy .... 85 fracture of 146 immediate treatment . 75 Fire, to extinguish in external . . 99- -102 clothes . . . 209 internal 103 Fits 204 situation of . ... 75 Flexion, forced . . 89 to arrest .... 40 Fly papers, poisonous 181 treatment of external . 99 Foot, bandage for . . . 3:i triangular bandage to Forearm, bandage for 28 arrest .... 40 Forehead, bandage for 22 varieties of . . 76 Foreign bodies, removal of 213 venous ... 40, 77 ', 78 Hair, dyes poisoning 186 Godfrey's cordial poi- Hall's method of artificial soning . . . 188 respiration 157, 161 Great toe, bandage for . 53 specific poisoning ... 181 Greenstick fracture of Hand, bandage for . . . 28 radius . . . 121 fracture of 146 Groin, bandage for . . . 37 Squire's method for bandaging . . 32 H^IMATEMKSIS .... 105 Hanging, asphyxia from 170 Haemoptysis .... 104 Head, bandage for . . 60 Haemorrhage 75 four-tailed bandage for 70 arterial 77 Heel, l)andage for . . . 53 articles required for Henbane poisoning . . . 186 controlling 221 Hip, bandage for , . 33 causes of 75 Holly berries poisoning . 186 caution respecting . . 40 Hooper's Specific poison- definition of 75 ing 181 "first aid "for . . . 80 Howard's method of arti- from axillary artery . 84 ficial respira- brachial artery . . . 85 tion . 157, 160 common carotid ar- Humerus, fracture of . . 141 tery ... 83 Hydrocyanic acid poison- facial artery . . 83 ing . 178 femoral artery . . . 86 Hyoscyamine poisoning . 186 occipital artery . . 83 Hysterical fits . . 205 popliteal artery . . 87 radial artery .... 85 IcE-CKEAM, poisonous 181 228 INDEX Infants, convulsions of . 205 Insects, stings of . . . . 115 Insensibility 192 test for 201 Intoxication, alcoholic . 199 Iodine poisoning .... 186 Iodoform poisoning . . . 186 Irritant poisons .... 173 Jaw, four-tailed bandage for 69 fracture of 129 Knee, bandage for . . 33, 55 four-tailed bandage for 71 Knot, reef 16 sailor's 16 Knotted bandage ... 63 Labuknum poisoning . 186 Laudanum poisoning . . 188 Laurel water poisoning . 178 Lead poisoning .... 186 acetate poisoning ... 186 paint poisoning . . . 186 sugar of, poisoning . . 186 •white poisoning ... 186 Leg, bandage for ... . 33 Limbs, extremities of, fix- ing splints to 38 Lime, caustic poisoning . 180 quick poisoning ... 180 Liqueurs poisoning . . . 188 Lower extremities, t o bandage ... 59 Lungs, bleeding from . . 104 Many-tailed bandage . 72 Matches, poisoning . . . 189 Mercury, acid nitrate poi- soning . . . 187 perchloride poisoning . 187 red oxide of, poisoning 187 Metacarpus, fracture of . 146 Monkshood poisoning . . 179 Morphine poisoning . . 188 Mushrooms, poisonous . 185 Mussels, poisonous ... 187 Narcotic poisons . . . 199 Neck, bandage for wound of 24 Nepenthe poisoning . . 188 Neuraline poisoning . . 179 Nicotine poisoning . . . 190 Nitrate of silver poisoning 183 Nitric acid poisoning . . 177 Nitro-benzol poisoning . 188 Nitrous acid gas poisoning 188 Nose, bleeding 106 removal of foreign bodies from . 214 Occipital artery ... 83 Oil of almonds poisoning 178 vitriol poisoning . . 177 Opium tincture poisoning 188 Wine, of, poisoning . 188 Oxalic acid poisoning . . 178 Paraffin oil poisoning 189 Paregoric poisoning . . 188 Patella, fracture of . . . 153 Peach kernels poisoning 178 Pelvis, fracture of ... 1 34 Perineum, bandage for . 35 Phenol poisoning . . . 178 Phosphorous poisoning . 189 Poisoned bites 115 wounds 114 Poisoning, classification of 172 definition of 172 INDEX 229 depression from . . . 175 evidence of 173 general treatment for . 174 history of 174 how to act in .... 174 immediate treatment of 172 pain, relief of, in . . . 175 shock from 175 unknown, general treat- ment .... 174 Poisonous fish and meat 187 Poisons, acetate of copper 184 lead 186 acids 177 acetic 177 arsenious 181 carbolic 178 carbonic 185 hydrochloric .... 177 hydrocyanic .... 178 nitric 177 oxalic 178 prussic 178 sulphuric 177 aconite 179 liniment of .... 179 aether 185 after damp 185 alcohol 180 alkalies 180 ammonia 180 caustic 180 liquid 180 liniment .... 180 lime 180 caustic 180 quick 180 potash 180 caustic 180 soda 180 caustic 180 178 178 180 188 187 181 181 181 176 176 almond flavor . oil ammonia . . . aniline dyes . . animal alkaloids antimony - . . tartarated . . antimonial wine aperients for . . castor oil, sulphate of magnesia (Ep- som salts) . . aqua fortis 177 Tofania 181 arnica 186 aromatic vinegar . . . 177 arsenic 181 white 181 arsenious acid .... 181 atropine 182 Battley's vermin killer 188 sedative solution . . 188 bean, St. Ignatius . . 188 belladonna 182 benzol 188 berries, holly .... 186 bites, mad dog and snake ... 116 bitter almonds .... 178 black drops 188 blister beetle .... 182 fluid 182 blue rocket . . • . . 179 stone 179 vitriol 184 brandy 180 Burnett's disinfecting fluid .... 190 Butler's vermin killer, 188 calminative, Dalby's . 189 camphene 190 230 INDEX Poisons (con tinned) camphor .183 essence of 1 83 liniment 183 spirits 183 cantliarides ..... 182 carbolic acid 178 carbonic acid ... 185 gas 185 oxide gas 185 caustic ammonia . . . 180 lime 180 lunar 183 potash 180 soda 180 chalks, P>ench . . 181, 186 charcoal fumes .... 185 chloral ..... .183 hydrate 183 syrup 183 chloride of antimony . 181 lime 183 chlorine gas 183 chlorodyne 188 chloroform, inhaled 183 swallowed 184 choke damp 185 coal gas 185 codeine 188 compound camphor lini- ment .... 183 copper 184 acetate 184 sulphate 184 cordial, Godfrey's . . 188 corrosive acids .... 178 sublimate 187 corrosives 177 crayons 181, 186 croton oil 185 cyanide of potassium 178 Poisons (continued) Dal1)y's calniinative 188 deadly nightshade . . 182 demulcents for arrowroot, barley w a t e r, eggs (raw), flour and water, gruel, linseed tea, milk, olive oil 177 dog bites J 16 Dover powder . . .188 drops, black 188 elixir, Godfrey's . . . 188 enierald green .... 181 emetics for ipecacuanha powder, ipecac uanha wine, mustard, salt, sulphate of zinc, tepid water . . . 175 enema for beef tea, spirits, tea or coffee . . 177 ergot of r^'e 185 ergotine 185 essence of camphor . . 183 henbane ... 188 ether, inhaled ... 185 fish, poisonous .... 187 fly fungi 185 papers 181 French chalks . . 181, 186 friend and soothing syrup, mother's 188 fruits, tinned .... 181 fungi 185 gases 185 acetylene 185 after damp .... 185 INDEX 231 Poisons (continued) carl)onic acid oxide . . . charcoal fumes chlorine . . choke damp . coal gas marsh gas nitrous oxide sewer gas . . gill glacial acetic acid Godfrey's cordial elixir hair dyes . . . hartshorn . . . henliane .... holly berries Hall's specific Hooper's specific Hunter's chloral hydrate of chloral hydrochloric acid hydrocyanic acid hyoscyamine hyoscyamus . . ices, cheap Ignatius, St. insect stings iodine . . iodoform irritants laburnum laudanum laughing gas laurel water lead . , acetate . hair dyes paint . . sugar of . bean and 185 185 185 183 185 185 185 188 185 180 177 188 186 180 186, 188 186 181 181 183 183 177 178 186 186 181 188 116 186 186 173 186 188 188 178 186 186 186 186 186 Poisons (continued) white 186 lime, caustic 180 quick 180 liniment, aconite . . 179 ammonia .... 18U belladonna .... 182 camphor .... 183 liqueurs 188 lunar, caustic .... 183 mad dog Ijites .... 116 matches 189 mercury 187 acid nitrate .... 187 perchloride .... 187 red oxide ..... 187 red and white precip- itate .... 187 methylated spirit . 180 mineral green .... 181 monkshood .... 179 morphine 188 mother's friend and soothing syrup 188 177 185 187 I'/S 173 179 190 182 183 177 188 188 188 188 178 178 190 muriatic acid mushrooms . . . mussels narcotic narcotic-irritants neuraline nicotine . . nightshade, deadly nitrate of silver . nitric acid . . . nitro-benzine . . nitro-benzol . . . nitrous oxide gas uux vomica . . . oil of almonds . . bitter .... turpentine . . 232 INDEX Poisons (continued) oil of vitriol 177 opium ....... 188 oxalic acid 178 oxide of mercury . . . 187 paint, lead 186 paraffin oil 189 paregoric ...... 188 paste for rats . . . 181, 189 peach kernels .... 178 perchloride of mercury 187 phenol 178 phosphorus .... 189 paste 189 poisonous fish .... 187 meat 187 mushrooms .... 185 pomades, as 188 poppies, syrup of . . . 188 potassium cyanide . . 178 proof spirit 180 prussic acid 178 ptomaines 187 quick lime .... 180 rat paste 181, 189 poison 189 rectified spirits . . . 180 red oxide of mercury . 187 precipitate .... 187 Ringeisen's rat paste and vermin killer . . 181-189 Roth's rat paste and vermin killer 181-189 rum 180 rye, ergot of 185 St. Ignatius bean . . 188 salts of lemon .... 178 sorrel 178 Scheele's emerald green 181 Poisons (continued) Scheele's prussic acid . 178 sedative solution, Bat- tley's. ... 188 sedatives for (see de- m ulcents above) . . 177 sewer gas 185 silver nitrate .... 183 snake bites 116 soda, caustic 180 soothing syrup, moth- er's 188 Spanish fly 182 spirit, methylated . . 180 proof 180 rectified 180 spirits of camphor . . 183 hartshorn .... 180 salt 177 turpentine ... 190 stimulants for beef tea, coffee (or tea), cold and hot douches al- ternately, sal volatile (aro- matic spirit of a m m o n i a), spirits (brandy or whiskey) stings of insects strong acids . strychnia . . sugar of lead sulphate of copper sulphuric acid sweetmeats . . syrup of chloral poppies . . soothing . . 176 116 177 188 186 184 177 188 183 188 188 INDEX 233 Poisons (continued) tartar emetic .... 181 tartarated antimony . 181 tin 190 impurities of . . . 181 tincture of opium . . 188 tinned fruits .... 181 tobacco 190 turpentine 190 oil of 190 spirits of 190 turps 190 verdigris 184 vermin killer 181, 188, 189 Vienna green .... 181 vitriol, blue 184 oil of 177 white 190 wall papers 181 whiskey 180 white arsenic .... 181 lead 186 precipitate .... 187 vitriol 190 wine of antimony . . 181 opium 188 zinc 190 chloride 190 sulphate 190 Pomades, poisonous . . 188 Popliteal artery .... 87 Posterior tibial artery . . 88 Potash caustic jwisoning 180 Poultices and fomenta- tions .... 221 Precipitate, red, poisoning 187 white, poisoning . . 187 Prussic acid poisoning . 178 Ptomaine poisoning . . 187 Quick lime poisoning . 180 Radial artery .... 87 Radius, fracture of . . . 144 Rat paste poisoning . . 189 Respiration, artificial 98, 157 Ribs, fracture of .... 132 Roller, bandages, kinds of 66 Roth and Ringeisen's ver- min killer poi- soning . . . 181 Rubini's solution poison- ing . . . • • 183 Salt, for wounds • 112 Salts of lemon poisoning 178 of sorrel poisoning . 178 Scalds, immediate treat- ment of . . . 207 Scalp, bandage for wounds of 20 Scheele's acid poisoning 178 emerald green poisoning 181 Scultetus, bandage of . . 72 Sedatives in poisoning . 177 Selection of sick room . 215 Shock 195 from burns 208 Shoulder, bandage for . 50 for wounds of . . . 24 Sick room, selection of . 215 Simpson's rat paste poi- soning . . . 189 Skull, fracture of .... 128 base of 128 Sling, broad arm . . . 17, 137 large 17 narrow 16 Snake bites 115 Soda caustic poisoning . 180 Soothing syrup poisoning 188 Spanish fly poisoning . . 182 Special bandages .... 69 234 INDEX Spica ])anda;ifs ... 52-56 S)Mne, fracture of . . . 131 Spirits of hartshorn poi- soning . . . 180 salt poisoning . . . 177 methylated, poisoning 180 ])roof, poisoning ... 180 rectified poisoning . . IhO Splint fixing to limb im- 38 provised 125 looped triangular band- age for ... 39 to apply 125 Sprain of thumb, bandage 53 Sprains 117 Sqnare bandage .... 69 S(iuire's bandage for palm 32 St. Ignatius bean poison- ing .... 188 Stimulants in poisoning cases .... 176 Stings of insects .... 115 S trangu lation , asphy x la from ... 170 Strychnine poisoning . . 188 Stump of limb, bandage for 37 Styptics 78 Subclavian artery ... 84 Sulphuric acid poisoning 177 Sunstroke 200 Sweetmeats, })oisonous . 188 Sylvester's method of ar- tificial respira- tion . . .98, 157 Syncope . . .97, 192 S3'rn}) of poppies, poison- ous .... 188 Tarsus, fracture of . . 156 Temporal artery .... 82 Thigh, bandage for ... 33 Tibia, comjjound fracture of 120 fracture of 155 Tin, salts of, poisoning . 190 Tinned fruits poisoning . 181 Tobacco poisoning . . 190 Tourniquet, to i m p r o - vise a . 40, 94 Transport of injured per- son . .126, 219 Turpentine poisoning . . 190 Twisted bandage .... 63 Ulnar artery ... 87 Unconsciousness action in case of ... 201 Upper extremities, to bandage . . 56 Uraiuiic convulsions . . 206 Varicose vein, how to treat a burst . 79 Verdigris poisoning , . . 184 Vermin killer poisoning 188, 189 Vitriol, blue, poisoning . 184 "white poisoning . . . 190 Volker's stick tonrni(|uet JJ6 Vomiting of blood . 103, 105 Wound of abdomen . . 26 arm 2(i chest . 25 chin 2-2 ears 22 elbow 27 eyes ..... 22 face 22 foot 33 INDEX 23^ foreliead 22 groin 37 hand 28 hip . 33 knee 33 leg 33 neck 24 palm 30 perinreum 35 scalp 20 shoulder 24 stump of limb .... 37 temple 22 thigh 33 wi-ist 28 Wounds bandages for 20 bullet 109 clean cut 108 contused 114 definition of 1(18 immediate treatment of 109 incised 118 lacerated . . . 109, 114 poisoned 108, 114 punctured 114 simple 108 staJ) 109 to cleanse Ill dress 112 Wrist, bandage for . . . 28 fracture of 146 Zinc, chloride of, poison- ing 190 POPULAR HAND-BOOKS COME books are designed lot entertainment, others for Informa- tion. ^ This series combines both features. The information is not only complete and reliable, it is compact and readable. In this busy, bulling age it is required that the information which books contain shall be ready to hand and be presented in the cleared and briefed manner possible. ^ These volumes are replet< with valuable information, compadl in form and unequalled in point of merit and cheapness. They are the late^ as ^ eil as the be^ books on the subjecfts of which they treat So one who wishes to have a fund of general information or \ ho has the desire for self-Improvement can afford to be without them. ^ They are 6 x A^A inches in size, well printed on good paper, handsomely bound in green cloth with a heavy paper wrapper to matcL Cloth, each 50 cents THE PENN PUBLISHING COMPANY 923 Atch Street. Philadelphia ETIQUETTE There 18 no oasspon »o good soci't% Sv Agnes H Morton &^e good manners. ^ Evei. ll:ough cne possess wealth and inteUigence, 1 is suc- cess in life may be marred by ignorance of social cu^oms ^ A perusal of this book will prevent such blunders. It ts =^ book for ever^^body, for the social 'eaders as well as foi those less arr'. -tious. ^ The subjed is presented in a bnght and *iig manner, and represents the late^ vogue LETTER WRITING Why do mo^ persons dislike lo By Agnes H. Morton vmte letters 7 Is it not because they cannot say the right thing m the right place ? This admirable book not only shows by numerous examples just what kind of letters to write, but bv diredliona and sugge^'ons enables the reader to become an accomplished original letter writer. ^ There are forms for eJ kinds of business and social letters, including invitations acceptances, letters of sympathy, congratulations, and 'ov* 'etters QUOTATIONS A clever compilation of pithy quota By Agnes H. 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PROVERBS The genius, wit, and spirit of a nabon By John H BechteJ are discovered in its proverbs, and the condensed wisdom of all ages and all nations is embodied in them. ^ A good proverb that fits the case is often a convincing argument. ^ This volume contains a representative colledion of proverbs, old and new. and the indexes, topical and alphabetical, enable one to fin This unique, up-to-date book answers thou Wids ol luSt «uch mtere^g and useful que^on& 4 Dictionary of Mo^ oi us disfike to look up . MYTHOLOGY mythological subjed because dyJohnH Bechtel ^^ '^^ time required. |81 This book remedies that difficulty because in it can be found at a glance ju^ what is wanted ^ It is comprehensive, convenient, condensed, and the infor mation is presented in such an intere^g manner that when once read it will always be remembered. ^ A di^indive feature of the book is the pronunciation of the proper names, something found in few other works SLIPS OF SPEECH Who does not mak- them? By John H Bechtci The be^ of us do. ^ Why not avoid them ? Any one inspired with the spint of self- improvement may readily do so. ^ No necessity for studying rules of grammar or rhetoric when this book may be had. It teaches both ivithout the ^udy ol either. ^ it is a counseDor, a cntic, a companion, and a guide, and is written in a mo^ entertaining and chatty ayle. HANDBOOK OF What is more disagreeable PI^ONUNCIATION l^an a faulty pronunciation? 8v John H Bechtel ^o othei defed so cl^rly shows a lack or culture. ^ Tins book contains over 5.000 words on which mo^ of us are apt to trip. ^ They are here pronounced in the cleared and «mple^ manner, and according to the be^ 'iiithority. ^ It is more readily consuited tlian a dictioiiary. and it lud