Susceptible people should avoid the plant if possible.

OTHER EMERGENCIES

CHILLS may be the result of infection or of exposure to cold. An early diagnosis of the trouble is so desirable that it is well to send for a doctor even when symptoms are not severe. If a person has a chill his temperature should be taken at once; fever and chill together probably indicate invasion by bacteria. When chills follow exposure to cold the patient should go to bed between warm blankets, his body should be briskly rubbed, and hot water bags and a hot drink should be given. If he prefers, he may take a hot bath before going to bed.

CROUP is caused by a spasmodic closure of the larynx so that breathing is impeded. The child who develops croup may have a slight cold, but frequently shows no symptoms until he wakes in the night with a hoa.r.s.e ringing cough and difficult breathing. True croup, though often distressing, is seldom serious, even when the symptoms are so severe that the child appears to be partly suffocated. An emetic should be given at once, preferably syrup of ipecac, one teaspoonful followed by warm water, or ten drops every 15 minutes until the child vomits freely.

Hot fomentations may be applied to the throat and chest in order to hasten relaxation of the muscular spasm, and water should be kept boiling near the bed in a teakettle or uncovered saucepan. The child should stay in a warm room during the following day.

Whenever a child develops a croupy cough his throat should be examined.

A physician should be summoned if the throat is red and especially if the redness is a.s.sociated with rise in temperature. Cases of diphtheria have been overlooked by neglecting such symptoms.

BLEEDING

In the vast majority of cases, bleeding can be stopped by elevating the injured part and applying pressure over the wound. One should, however, remember that loss of blood is not the only danger presented by an open wound, for pus-producing germs, if they make their entrance, may cause an infection which may be as serious as the bleeding itself. Hence in dealing with open wounds of any sort one should always keep in mind the danger of infection as well as the danger from loss of blood.

TREATMENT OF SLIGHT WOUNDS.--Loss of blood from slight wounds is seldom so serious as the danger of infection; therefore small cuts, pin p.r.i.c.ks, scratches, etc. should be encouraged to bleed by pressure near the wound in order to expel the germs that may have entered. After the wound has bled a little, tincture of iodine should be applied by means of a cotton swab both to the wound itself and also to the surrounding skin.

After the wound has thus been disinfected it should be covered with a sterile dressing; a sterile or aseptic dressing is material in which all bacterial life has been destroyed. Gauze from a First Aid dressing or from a packet of sterile gauze should be used for this compress, or gauze may be cut from a sterile bandage. The compress serves two purposes: it protects the wound from infection, and if applied with pressure it checks further bleeding.

The compress should be securely bandaged in place, or its edges may be fastened with adhesive plaster or collodion. Neither of the two latter should cover the wound itself. The outside bandage may be changed when soiled, but the compress itself should not be disturbed until the wound has healed. It is a mistake to dress wounds oftener than necessary, since handling them always increases the chance of introducing germs.

Most children, like Tom Sawyer, delight in wounds, but they should be prevented if possible both from inspecting and from exhibiting them.

If heat, swelling, redness, or pain develop in a wound after a day or two, a doctor should be consulted; and not a minute should be lost if the patient has a chill or if red streaks appear extending from the wound in the general direction of the heart. Until the doctor comes the wounded part should be elevated and covered with cold applications wet in alcohol 25%, or in a solution of common salt, a teaspoonful to a pint of water.

Several points should be remembered in dressing wounds. In the first place the mouth, which is full of germs, is not a good place for cut fingers. Moreover, wounds should not be touched by anything, especially the fingers, either washed or unwashed, nor should the scissors, fingers or other object be allowed to touch the surface of the dressing that is to be placed directly upon a wound. Unless they contain gross dirt wounds should not be washed with water, since washing introduces another chance of infection and accomplishes nothing except a tidy appearance, which is not essential. Furthermore, it should be remembered that exposure to the air will not infect a wound, and therefore time should be taken to find a suitable dressing. When a sterile dressing is quite impossible to obtain, the cleanest material available should be used; one of the best subst.i.tutes for a sterile dressing is the inner surface of a handkerchief or napkin that has not previously been unfolded since it was ironed. It is a common mistake to tie up a wound in the first article presented, which is usually a generous by-stander's soiled handkerchief. The same precautions in regard to cleanliness should be taken in dressing wounds that are known to be contaminated, since even into an infected wound it is possible to introduce more germs and more virulent ones.

NOSEBLEED usually stops of itself, but if it is obstinate the patient should sit erect with the head back, and cold compresses should be placed on the nose and at the back of the neck. Pressure should be made on the upper lip by means of the fingers, or by a firm roll of paper or cotton placed under the upper lip. Salt or vinegar in water, a teaspoonful of either one to a cup of water, may be snuffed up the nose.

The treatment should be continued for ten or fifteen minutes, or until bleeding stops; if the bleeding persists a doctor is needed.

PROFUSE MENSTRUATION should be treated by keeping the patient quiet in bed with the head low and the feet slightly elevated. "Any marked increase, whether by amount, duration, or shortening of the interval between the periods ought to receive attention and be brought to the physician's notice" (Latimer). Painful menstruation may be relieved by rest in bed, mental as well as physical, by hot drinks and by the application of heat. Rest, and hygienic living persistently practised, will relieve most menstrual abnormalities. The common practice of using patent remedies and alcoholic liquors for disordered menstruation cannot be too strongly condemned.

OTHER INJURIES

SPRAINS.--A sprain is caused by twisting, stretching, or tearing the tissues about a joint. The first sharp pain comes from the injury to the tissues; subsequent pain is caused by the pressure of acc.u.mulated fluid. The other symptoms are those characteristic of inflammation.

When a sprain is slight, the affected part should be elevated and kept at rest for the first twenty-four hours. Either heat or cold should be applied, or heat and cold alternately; a good treatment is to soak the part in hot water and afterward to allow cold water to run upon it from the tap. Gentle rubbing with a circular motion helps to reduce the swelling. If the joint must be used it should be bandaged tightly.

Injuries to joints should never be neglected; and severe sprains always require medical attention, since in addition to the sprain a bone may be broken. A severely sprained joint should be elevated, treated with hot or cold applications, and kept at rest until it has been examined by a physician.

BRUISES.--Bruises need no attention unless they are extensive or painful. The skin should be kept clean and if possible unbroken, since injured tissues are less resistant to infection than tissues in their normal state. Applications of cold water or of equal parts of cold water and alcohol may relieve the pain, but cold should not be used upon bruises that are extensive. A compress bandaged tightly in place may help to prevent swelling and discoloration.

BURNS AND SCALDS.--Injuries from dry heat are called burns, and those from moist heat are called scalds. Both are painful, and both are dangerous if extensive or deep. Burns and scalds require medical attention if the injured area is extensive, if a large blister is formed, if the skin is destroyed or charred, and if symptoms of shock appear. Shock often follows burns or scalds even when the injury is comparatively slight.

Treatment of slight burns, where the skin is reddened but not destroyed, has for its main object the exclusion of air. One of the following may be applied: dry baking soda, or baking soda made into a paste with water, picric acid gauze moistened in water, boracic acid ointment, vaseline, sweet oil, or castor oil; if none of these is obtainable, lard, cream, the white of an egg or unsalted b.u.t.ter may be used. Old muslin or linen bandaged lightly in place, should be used to cover the burn.

The same treatment is used for sunburn, and also for small burns where blisters form. A blister, if it forms, should not be punctured; but if it is accidentally broken the skin of the blister should not be removed.

It should be remembered that a broken blister is an open wound, and therefore liable to infection.

BRUSH BURN is a name given to injuries where the surface of the skin has been removed. They include the sc.r.a.ped arms and legs which are common accidents in childhood. In order to dress a brush burn, particles of dirt should first be removed preferably by means of forceps that have been boiled, and the surrounding skin should then be cleansed with soap and water. The injured part should next be flushed with sterile salt solution, made by boiling water five minutes and adding to it salt in the proportion of one teaspoonful to a pint of water. If the dirt is difficult to remove a soap compress should be applied. To prepare the compress several thicknesses of gauze or muslin should be boiled in a strong solution of castile or green soap for ten minutes. The compress should remain in place several hours, and may be repeated if necessary.

After the wound has been thoroughly cleansed, it should be dressed with old muslin that has been saturated in castor oil or spread with boracic ointment.

EXERCISES

1. Name some common causes of headache and of sleeplessness, and outline rational treatment for each of these disorders.

2. Describe symptoms and treatment of shock; of fainting; of convulsions in children.

3. Describe the treatment of all disturbances of the digestive tract mentioned in this book.

4. What should be done if a foreign body has entered the eye? if one has entered the ear? What should be done for a person who has a stye? for a person with pain in or near the ear?

5. How would you treat a sprain?

6. Describe treatment for burns and scalds.

7. Distinguish between heat stroke and heat prostration, and tell what treatment should be given in each case.

8. What are the two princ.i.p.al dangers from slight wounds, and how should one guard against them? Show how you would dress a small cut.

9. What should you do for a person with nose bleed?

FOR FURTHER READING

American National Red Cross Text Book on First Aid--Lynch.

Immediate Care of the Injured--Morrow.

Prompt Aid to the Injured--Doty.

CHAPTER XIV

SPECIAL POINTS IN THE CARE OF CHILDREN, CONVALESCENTS, CHRONICS, AND THE AGED

In many cases of sickness inst.i.tutional care has marked advantages. It may be the only solution when adequate provision for the sick is impossible at home; and it is often a necessity when a patient requires special equipment or apparatus, expert nursing, and medical attention within reach both day and night.

On the other hand, it would not be desirable even if it were possible for all sick persons to be cared for in inst.i.tutions. Care at home when it is adequate may be more successful than equally skillful care given elsewhere, since the sick quite as much as the well are injured by long separation from normal family life. Most children, because they need the attention of their own mothers, most convalescent and chronic patients, and most aged persons are cared for at home; and in the great majority of cases no better place for them could be found. Since patients of these four groups have needs peculiar to themselves, some special points in caring for them are considered in this chapter.

CHILDREN