4. Loosen the clothing, especially any band around the neck, tight corsets or anything else that may interfere with breathing.

5. _Keep the patient flat on his back_ if the accident is at all serious, with the head slightly down if his face is pale and he is faint, or slightly raised if his face is flushed and he is breathing heavily, as though snoring.

6. _If there is vomiting_, turn the head to one side in order that the vomited material may easily run out of the mouth and not be drawn into the windpipe and produce choking to add to the difficulties already present.

7. _Remove clothing_, if necessary, gently and in such manner as to give the patient the least amount of suffering. Move any injured part as little as possible. At the same time, as a secondary consideration, injure the clothing as little as possible. If, as often, it becomes necessary to cut off the clothing, it may be possible to rip up a seam quickly instead of cutting the cloth, but saving the clothing is always secondary to the welfare of the patient. Little or no consideration should be shown for clothing where it is necessary to keep the patient motionless, or where quick action is needed.

8. _Transportation._ There are three methods for emergency transportation of accident victims which can be used according to the degree of the injury:

(a) _Fireman's Lift._ If it is necessary for one person to carry a patient, it is easily possible to lift and carry quite a weight in the following manner:

First, turn the patient on his face, then step astride his body, facing toward his head, and, with hands under his armpits, lift him to his knees, then clasp your hands over the patient's abdomen and lift him to his feet; then draw his left arm around your neck and hold it against the left side of your chest, the patient's left side resting against your body, and supporting him with your right arm about the waist. Then drop the patient's left hand and grasp his right wrist with your left hand and draw the right arm over your head and down upon your left chest; then stooping, clasp his right thigh with your right arm pa.s.sed between the legs (or around both legs) and with a quick heave lift the patient to your shoulders and seize his right wrist with your right hand, and lastly, grasp the patient's left hand with your left hand to steady him against your body. (Work this out with a companion as you read it.)

(b) A seat made of four arms and hands (which you have no doubt used in your play), may be used for the lesser injuries. If the patient can, he supports himself by putting his arms around the necks of his carriers, each of whom in the meantime grasps one of his own wrists and one of his partner's. This makes a comfortable seat for carrying. If the patient needs supporting, a back may be improvised by each carrier grasping the other's arm below the shoulder to form the back and their other hands clasped to form the seat. A better seat may be made with three hands clasping the wrists, while the fourth arm is used as a back, by one clasping the other's arm below the shoulder. This does not provide a very secure back, however, as it is not easy to hold the arm against much of a weight from the patient's body.

(c) _Improvised Stretcher._ When the patient shows any sign of shock, is unconscious, has a serious fracture of some bone or bones, has a serious injury to any part of the body, or is bleeding excessively, he must be carried lying down. It may be that there will be no regular stretcher at hand. In that case one must be improvised. A serviceable one can be made from ordinary grain or flour bags by cutting the two corners at the bottom and running two poles inside the mouth of the bags and through the holes.

A workable stretcher can be made from coats by turning the sleeves inside out, pa.s.sing the poles through the sleeves and b.u.t.toning the coat over the poles. This brings the turned sleeves on the inside. A five-bar gate or a door, if it can be gotten without delay, also make satisfactory emergency stretchers.

A stretcher may also be made out of dress skirts, with or without poles.

Put the skirts together, bottoms slipped past each other, and slip the poles through, as with the bags. If no poles are available, roll the edges of the skirts over several times to form a firm edge, and carry with two or four bearers, as the size and weight of the patient make necessary.

Minor Injuries and Emergencies

Minor injuries may or may not need the aid of a doctor, and you must learn to use judgment as to the necessity of sending for one. We will consider these minor injuries in groups to remember them more easily.

1. (a) BRUISES; (b) STRAINS; (c) SPRAINS

(a) A _Bruise_ is produced by a blow which does not break the skin, but does break the delicate walls of the capillaries and smaller veins, thus permitting the blood to flow into the surrounding tissues, producing the discoloration known as "black and blue."

(b) _A Strain_ is produced by the overstretching of muscles or ligaments, or both, but not tearing them. It may or may not be accompanied by breaking of capillary walls with discoloration. Any muscle or ligament may be strained.

(c) _A Sprain_ is produced by the overstretching of the muscles or ligaments or both about a _joint_. There may also be some tearing of the fibres or tearing loose from their attachments. This always breaks capillaries or small veins, making the surface black and blue. This discoloration usually appears some time after the accident, because the broken blood vessels are far below the surface.

_Treatment_--For bruises and strains it is seldom necessary to call a doctor. Apply cold, either by wringing cloths out of cold water and applying, or by holding the injured part under the cold water tap. Do this at intervals of several hours, until the pain is lessened. The cold may be alternated with hot water which must, however, be quite hot, just enough not to burn, as lukewarm water is almost useless. Some patients will prefer to use only hot water. The water followed by applications of tincture of arnica, witch hazel, or alcohol and water, half and half, and bandaging will be sufficient.

If, however, there has been no black and blue at first, as in a bruise, but it begins to show later, and the pain continues severe, and there is a good deal of swelling, then you should send for a doctor, as more than first aid is needed.

In case of _sprain_, send for a doctor, and in the meantime elevate the joint and apply hot or cold water, or alternate hot and cold, as patient prefers. This will give relief by contracting the blood vessels.

2. (a) BURNS; (b) SCALDS; (c) SUNBURN; (d) FROSTBITE

(a) _Burns_ are produced by dry heat, as a fire, acids, alkalis, etc., and may be of all degrees, from a superficial reddening of the skin to a burning of the tissues to the bone.

(b) _Scalds_ are produced by moist heat, and may be of the same degrees as those produced by dry heat.

(c) _Sunburn_ is produced by the sun, and is usually superficial, but may be quite severe.

(d) _Frostbite_ is produced by freezing the tissues and is usually not dangerous. The more severe types will be treated later under Freezing.

_Treatment_--(a) _Burns_; (b) _Scalds_

1. Except in the minor burns and scalds, send for the doctor at once.

2. The first thing to do is allay pain by protecting the injured part from the air.

3. For a burn produced by fire, cover with a paste made of baking soda and water, or smear with grease--as lard, carron oil (mixture of linseed oil and lime water--half and half) or vaseline or calendula cerate.

Cover with a piece of clean cloth or absorbent gauze and bandage loosely or tie in place. Gauze prepared with picric acid, if at hand, is a most satisfactory dressing. It can be purchased and kept on hand for emergencies.

4. In burns from alkalis or acids, wash off as quickly as possible and neutralize (make inactive the acids with baking soda, weak ammonia or soapsuds; the alkalis with vinegar or lemon juice). Afterward treat like other burns.

(c) _Sunburn_ is an inflammation of the skin produced by the action of the sun's rays and may be prevented by gradually accustoming the skin to exposure to the sun. It is treated as are other minor burns.

(d) _Frostbite_--_Prevention_--1. Wear sufficient clothing in cold weather and keep exposed parts, such as ears and fingers, covered.

2. Rub vigorously any part that has become cold. This brings the warm blood to the surface and prevents chilling.

3. Keep in action when exposed to the cold for any length of time. The signs of danger are sudden lack of feeling in an exposed part, and a noticeably white area. Chilblain is an example of frostbite.

_Treatment_--The circulation of the blood through the frozen part must be restored gradually. This must be done by rubbing the part first with cold water, which will be slightly warmer than the frozen part, and _gradually_ warming the water until the circulation and warmth is fully restored. Then treat as a minor burn. If heat is applied suddenly it causes death of frozen parts.

3. SPLINTERS, SMALL CUTS, SCRATCHES AND PIN p.r.i.c.kS

None of these injuries will usually require a doctor if properly treated in the beginning. The bleeding from any of them is not sufficient to be dangerous. But whenever there is a break in the skin or mucous membrane there is danger of infection by germs, and this is what makes the first aid treatment in these cases so important. A tiny scratch is sometimes converted into a bad case of blood poisoning by not being properly treated at first.

Splinters should be removed by using a needle (not a pin) which has been sterilized by pa.s.sing it through a flame (the flame of a match will do if nothing better is at hand). After the splinter is out, the wound is treated like a cut or scratch.

The germs which produce poisoning do not float in the air, but may be conveyed by any thing which is not sterile, as, for instance, the splinter or the instrument that did the cutting, scratching or p.r.i.c.king.

They may be carried to the scratch by our hands, by water, or cloth used for dressings.

_Treatment_--Wash your own hands thoroughly with soap and water, using a nail brush. Clean the injured part well with disinfectant, as, for instance, alcohol and water, half and half, or peroxide of hydrogen--paint the spot with iodine, and cover with sterile gauze (if this is not to be had, use a piece of clean cloth that has been recently ironed), and bandage in place. If the bleeding is severe, a little pressure with the bandage over the dressing will stop it. Use the same precautions if the wound has to be re-dressed.

4. STINGS AND BITES OF INSECTS

The poison injected by the sting or bite of an insect is usually acid, and the part should be washed at once with a solution of ammonia or soda (washing soda) to neutralize the poison. Then apply a paste of soda bicarbonate (baking soda) or wet salt and bandage in place. If the sting is left in the wound it must be pulled out before beginning treatment.

5. FOREIGN BODIES IN THE (a) EYE (Cinder) (b) EAR (Insect), (c) NOSE (b.u.t.ton)

(a) _Eye_--If a cinder, eyelash, or any tiny speck gets into the eye it causes acute pain, and in a few minutes considerable redness.

_Treatment_--Do not rub the eye, as this may press the object into the tender cornea so that it can be removed only with difficulty and by a physician. First close the eye gently, pull the eyelid free of the ball, and the tears may wash out the speck. If this is not successful, close the eye, hold the lid free, and blow the nose hard. You may then be able to see the speck and remove it with a bit of clean cotton or the corner of a clean handkerchief. If the object is lodged under the lid, and the foregoing efforts do not dislodge it, proceed to turn the lid up as follows:

Ask the patient to look at the floor, keeping the eyeball as stationary as possible. Take a clean wooden toothpick or slender pencil, wrapped with cotton, place on the upper lid about one-fourth of an inch from the edge, grasp the eyelashes with the other hand, give a slight push downward toward the cheek with the toothpick, a slight pull upward on the lashes and turn the lid over the toothpick. Remove the speck and slip the lid back in position. Wash the eye with boric acid solution.