This means that there will be one part of the drug, or of the liquid medicine, to 500, or 1000 parts of water. For example if you were asked to make up a solution of bichloride of mercury in the strength of 1 to 4000, you would use one ounce of bichloride of mercury to four thousand ounces of water, or one grain of the mercury to four thousand drops of water,--one grain being equivalent to one drop.

Sometimes solutions are made up on the percentage basis. For example, a five per cent. solution of carbolic acid. In this case it would be necessary to take five ounces of carbolic to one hundred ounces of water, or five drops of carbolic to one hundred drops of water.

CHAPTER x.x.xIX

ACCIDENTS AND EMERGENCIES

Accidents and Emergencies--Contents of the Family Medicine Chest--Foreign Bodies in the Eye--Foreign Bodies in the Ear--Foreign Bodies in the Nose--Foreign Bodies in the Throat--A Bruise or Contusion--Wounds--Arrest of Hemorrhage--Removal of Foreign Bodies from a Wound--Cleansing a Wound--Closing and Dressing Wounds--The Condition of Shock--Dog Bites--Sprains--Dislocations--Wounds of the Scalp--Run-around--Felon--Whitlow--Burns and Scalds

Contents of the Family Medicine Chest.--The family medicine cabinet should contain the following articles: a graduate, medicine droppers, hot water bags, a flat ice bag, a fountain syringe, a Davidson's syringe, a baby syringe, sterile gauze, absorbent cotton, gauze bandages of various widths, a yard of oiled silk, one roll of one inch "Z O"

adhesive plaster, a bottle of Pearson's creolin, hydrogen peroxide (fresh), one ounce tincture of iodine in an air-tight bottle, a can of Colman's mustard, two ounces of syrup of ipecac, a bottle of castor oil (fresh), one pound of boracic acid powder, one pound of boracic acid crystal, a bottle of glycerine, a bottle of white vaseline, a bath thermometer, some good whisky or brandy, aromatic spirits of ammonia, smelling salts, pure sodium bicarbonate, oil of cloves for an aching gum or toothache, a bottle of alkolol for mouth wash and gargle, and one ounce of the following ointment for use in the various emergencies which occur in all homes,--

Bis.m.u.th subnitrate dram one Zinc oxide dram one Phenol (95%) drops twelve Resinol ointment to make ounce one

This ointment may be applied to all cuts, bruises, skin eruptions, chafings and sores of minor importance. It is one of the best applications for chafing of the skin in babies.

The medicine chest should also contain a small jar of Unguentine for burns; one-tenth grain calomel tablets for a cathartic for baby to be used as explained in the text of the book, or as advised by the physician. It may also contain tablets for colds and for other purposes as suggested by the family physician. It should never contain medicines the use of which is not thoroughly understood by the mother. It is a wrong practice for mothers to keep medicines to use for the same ailment at a subsequent time. The ailment may not be the same and frequently the medicine itself deteriorates, or it may get stronger with age. Many medicines are made with alcohol in them. If kept for some time the alcohol evaporates and leaves a concentrated mixture which, if given in the dose meant for the fresh preparation, may poison a child. Such cases of poisoning are on record. The same argument applies to powders.

Certain drugs lose their strength, some absorb moisture, others change their chemical strength if kept mixed with other chemicals. They should be thrown away after the case is over if they have not been used. It is a dangerous practice to keep medicines around if there are children in the family.

Foreign Bodies in the Eye.--Particles which accidentally lodge in the eye are usually located on the under surface of the upper lid. They are sometimes, however, found on the ball of the eye or on the inner aspect of the lower lid. Foreign bodies which are propelled into the eye with great force, as iron specks which railroad men frequently get sometimes imbed themselves into the eye-ball and have to be cut out or dug out.

The entrance of the foreign particle is always accompanied by a flow of tears which is nature's way of removing them. The offending object may escape through the tear duct into the nose, or it may be simply washed out with the flow of tears. Rubbing the well eye will cause a flow of tears in both eyes and may facilitate removal of the foreign matter.

Blowing the nose may force the particle into the tear duct. The use of the eye cup may help in ridding the eye of the body. The same object may be accomplished if the eyes are immersed in a basin of water and opened wide. Then by moving the eyes around the particle may be washed out. If the particle is located on the under surface of the upper lid it may be promptly removed by pulling the upper lid forcibly down and over the lower lid. The eyelashes of the lower lid act as a brush and as a rule quickly remove the irritant if the procedure is carried out adroitly.

Everting the upper lid is a means of locating the body and in making possible its removal by a small camel's hair brush or corner of a handkerchief. To evert the upper lid it is necessary to employ a guide.

A match stem may be used in an emergency. This is laid across the middle of the upper lid, the eye lashes are grasped with the fingers of the other hand and the lid is bent over the match stem and turned up thus everting or turning inside out the entire upper lid. The procedure may be facilitated if the patient is instructed to look down while the operator is drawing the eye-lid upward.

If the particle cannot be easily removed by any of the above methods it is not safe for an uninstructed individual to go any further. The eye is an exceedingly delicate organ and may be permanently injured by unnecessary irritation. It is always safer and it may be cheaper in the long run to consult a competent oculist in such cases.

After the removal of any object from the eye, it is desirable to frequently wash it out with a saturated solution of boracic acid. This mixture will allay any inflammation and will tend to restore the normal condition more quickly and more satisfactorily than if the eye were left to heal itself.

Foreign Bodies in the Ear.--When a foreign body gets into the ear mothers are unnecessarily alarmed because of a failure to appreciate that the ear is a closed pa.s.sage. It is impossible for any object to get into the ear itself; the depth of the external pa.s.sage is only about one inch in an adult. At this point the pa.s.sage is completely closed by the drum membrane. Most of the harm is done by ignorant meddling, not by the object itself.

Children frequently put foreign bodies in the ear, as, b.u.t.tons, pebbles, beans, cherry stones, coffee, etc. The very first thing for the mother to do when she learns that her child has put "something" in its ear is to keep cool, and try to find out what the something is. It is essential to know what the article is because different articles are treated differently. For example if we try to remove a bean or pea with a syringe, the liquid will cause the pea or bean to swell and result in wedging it in so firmly that it will be impossible to dislodge it in this way.

If the object is hard, as a marble, b.u.t.ton, pebble, bead, the greatest care must be exercised. Try to make the object fall out. To effect this, turn the child's head downward with the injured ear toward the floor.

Then pull the lobe of the ear outward and backward so as to straighten the ca.n.a.l. A teaspoonful of olive oil poured into the ear will aid in its expulsion. If after the oil is poured in, the head is suddenly turned as above described the object will fall out. A very effective way to remove a hard object is to take a small camel's hair brush and coat the end with glue, or any other adhesive substance, then place it in contact with the object and permit it to remain long enough to become firmly attached after which it may be gently pulled out with the object attached. Never employ an instrument in the ear to remove a foreign body.

When a live insect or fly enters the ear a number of safe methods may be developed. If the ear is immediately turned to a bright light the insect may come out of its own accord. It may be floated out with salt water, or it may be smothered with sweet oil or castor oil after which it may be floated or syringed out. If it is necessary to employ a syringe this should be used gently. A foreign body may remain in the ear for days or weeks without doing any harm. This suggests that any unnecessary poking or prying should not be undertaken, because this may wedge it in tighter and to injure the drum membrane.

Foreign Bodies in the Nose.--Children may put any of these articles into the nose. Very often they do, and do not know enough to tell. If such is the case the first symptom calling attention to the fact that something is wrong is the appearance of a thick foul discharge from one nostril or some obstruction to breathing on the same side.

When the foreign body may be seen the child should be made to blow the nose, first closing the well side with the finger. If this does not expel the object the child should be made to sneeze by tickling the free nostril with a feather or by taking snuff. The mother should never permit the use of instruments by one unskilled in an effort to rid the nose of an obstruction. There is great danger of seriously injuring the delicate structure of the nose in this way or of pushing the object so far in that it may necessitate an operation to extract it. It is much safer to seek medical aid before any damage is effected. It seldom does harm to wait until the right a.s.sistance is at hand; it often does serious harm to be too smart in these little matters.

Foreign Bodies in the Throat.--If the foreign body is in the upper part of the throat and can be seen it may be removed with any instrument that can grasp it. The child may be immediately held up by its feet when the article may be shaken out. If it is further back or in the air pa.s.sages the child should be made to vomit by tickling the throat with a feather or with the finger held in the throat till it does vomit.

When the object interferes with breathing a physician should be sent for in a hurry. In the meantime the family may try to dislodge it by having the child bend forward or by holding it with the head downward and, while in this position, sharply striking the back with each cough.

Striking the chest when in this position may effect the same purpose. If no success follows this procedure try the reverse position. Have the child bend backward over the arm of a sofa, for example, or put him in bed with the body hanging out of the bed face upward. If none of these effect relief you must depend upon the skill of the physician.

A Bruise or Contusion.--A bruise or contusion is an injury to the tissues underneath the skin, but this does not imply that the skin itself is opened or damaged. In every bruise the small blood vessels are ruptured, and the blood collects in the tissues causing distention, swelling and pain. The blood is held in the tissues, it is stagnant, becomes dark in color and so produces the bluish discoloration that we see in all bruises. The color varies according to the extent of the collected blood. At first it is red and inflamed looking, then purple, then black, then greenish and finally citron. The so-called "black-eye"

is a typical example of this degree of bruise. After a bruise the parts swell from the collection of blood and from the accompanying inflammation. This causes pain which persists for a day although the spot may be sore and tender for a week or more.

In all mild varieties home remedies may suffice, but in the more serious and extensive bruises it is advisable to seek medical a.s.sistance. It is essential to completely put the part to rest and to elevate it. This will relieve the pain and favor the absorption of the exuded blood. If the bruise is on the foot, the leg should be elevated until the foot is higher than the hip. If, on the hand, it should be so held that it will be higher than the elbow and it may frequently be held higher than the shoulder to relieve the throbbing and the pain.

As a rule, cold should be applied as soon after the injury as possible, cloths wrung out of ice water, or a piece of ice may be bound on the part for a short time. The object of the cold is to stop the internal bleeding. If the injury is slight, as are most of the injuries of the household, the mother may apply repeated cloths wrung out of very hot water. This procedure tends to aid the immediate absorption of the blood and prevents a discoloration of the part. If there is great pain relief may be afforded by applying a firm bandage saturated in the lead-water and laudanum mixture which may be obtained in the drug store under the name of lead and opium wash. The bruised part should be ma.s.saged every day and a simple ointment may be applied to soften the inflamed area.

If any complication arises in the treatment of a bruise, it will be necessary to consult a physician.

Wounds.--A wound implies an injury to the skin in addition to injury to the underlying parts to a lesser or greater extent. The skin may be opened by cutting, or stabbing wounds; or it may be punctured, torn, contused, or bruised open. These injuries are effected in various ways.

We speak of machinery or mechanical wounds, or gunshot wounds, bites, cuts, stabs and other varieties of wounds.

It is very important to know exactly how a wound is produced and the nature of the instrument which opened the skin. We try to obtain this information in order to estimate the probable degree of poison that may or may not have entered into the wound.

The first thing to do in treating wounds is to stop the bleeding. If the patient is suffering from shock he should be given active treatment for this condition as described elsewhere. If the wound contains any foreign bodies these should be removed. The wound should then be cleansed, closed and dressed and kept at rest. If the wound is poisoned, or if there is any fear that lockjaw may arise, or if the wound has been caused by a mad dog it will require special treatment.

It is far better not to interfere if you do not know what to do than to do harm. One should offer no advice if they are not qualified to give advice. Much harm has resulted from doing the wrong thing in these cases. The instruction in the following pages is given so that the average mother may know what to do in emergency but not with the intention that she may regard her knowledge as sufficient to dispense with the aid of the physician.

Arrest of Hemorrhage.--When there is a wound there is always bleeding; this means that some blood vessels have been cut or torn open allowing blood to escape. The character of the hemorrhage will determine the nature of the treatment to be employed. On general principles, the first thing to do in the presence of bleeding is to elevate the part, if that is possible. If there is simply a general oozing of blood, it may be controlled and arrested by pressure. This pressure should be steady and prolonged. It is best accomplished by wetting a clean handkerchief or a pad of gauze in ice cold water, placing this on the part and binding it on firmly with a bandage.

If the discharge of blood flows in a steady stream and is rather dark the hemorrhage is coming from a vein. We know that veins carry blood toward the heart so that any pressure or constriction employed to stop a venous hemorrhage should be tied on the side of the wound further removed from the heart. Inasmuch as veins have soft walls the right kind of pressure will in most instances stop the bleeding. The part should be elevated after the pad is adjusted in place. Any tight band on the limb as a garter or sleeve band should be removed as they tend to interrupt the return circulation.

If the hemorrhage is from an artery the blood is bright red. It spurts out forcibly, is difficult to control and demands immediate attention.

Arteries carry the blood from the heart to the extremities. They beat with every pulsation of the heart so that blood coming from an artery spurts with every pulse beat. Even a small artery may be responsible for a very considerable hemorrhage in a very short time. Whatever is done must be done quickly. The parts should be freed from all clothing and if possible elevated. Pressure may be tried, if it succeeds it must be strong and steady pressure. The point to press must be on the heart side of the bleeding artery since the blood stream is coming that way--this the mother will note is the reverse from treating bleeding from a vein as previously explained. The artery at this point may be felt beating.

It is frequently necessary to clamp the whole limb to stop an arterial hemorrhage. This may be done in the following manner. Take a strong piece of cloth or bandage and tie above the bleeding point. Insert a short piece of stick between the bandage and the limb and twist around until the bleeding stops. This should not be kept on longer than one hour. A tourniquet of this character shuts off all the blood in the limb and if kept on too long the parts may mortify. The best means to stop a hemorrhage of this character is by means of a rubber bandage sold for the purpose. It is applied by stretching at every turn. It exerts uniform pressure and in this way does no injury to the parts. All these measures are, of course, only temporary expedients as the artery will finally have to be caught and tied by a physician.

Removal of Foreign Bodies From a Wound.--When the foreign bodies are large enough to be seen they may be picked out with the fingers after the hands have been rendered sterile. Smaller bodies may be picked up with forceps, or they may be washed out with water that has been boiled and cooled slightly, or a bichloride of mercury solution in the strength of 1 to 2000 may be used; or a normal salt solution may be used. As a general rule the physician should be allowed to undertake this procedure so that you may not be blamed for something that may come up later.

Cleansing a Wound.--The simplest way, and the most effective, to cleanse a wound, no matter how caused, is to procure a brush and paint it thoroughly with tincture of iodine. The iodine should be painted right into the raw wound, it is then bound up and left if it is small and does not need any st.i.tching. When the physician comes he can attend to any further procedure that may be necessary.

Closing and Dressing Wounds.--If the wound is small, its edges may be drawn together with narrow strips of adhesive bandage after it has been painted with iodine. It is then bound up and kept at rest. It should be inspected the following day to see if it is healing properly.

If the wound is large or torn, it should be seen by a physician and dressed and closed by him. All wounds do better if they are kept at rest.

The Condition of Shock.--When a person suffers a serious injury, loses a large quant.i.ty of blood, or is subjected to a profound emotion, it affects the vital powers to such an extent that the individual is said to be suffering from shock. Shock expresses itself in varying degrees of apathy. The patient may or may not be conscious. If conscious he gives no evidence of feeling, he is silent and motionless although he will respond to directions and may answer questions. The eyes are dull and listless, the face pale and pinched, and the general expression is apathetic. The skin is cold and there may be perspiration; the pulse is feeble and irregular, and the breathing is shallow. The whole att.i.tude of the victim is one of indifference and apparent inability to appreciate the seriousness of the situation and a seeming immunity to pain or discomfort.

When this condition exists it must always be regarded as serious because the patient may die as a direct result of the condition of shock. The various symptoms depend upon a temporary paralysis of the blood vessels which deprives the brain of blood. There is always a certain degree of shock with all injuries. Mothers should know what to do in these cases before the physician comes. The general treatment in all cases is to keep the patient warm and quiet, and to use stimulants carefully.

The patient should be put in bed or on a flat surface with the feet higher than the head. If raising the feet should cause the face to become blue it will be advisable to restore the patient to the horizontal posture. Artificial heat must be applied to the patient's body and extremities by means of hot water bags, bottles, bricks, plates, or any other handy device. Blankets should be put around the patient and every possible means resorted to, to maintain body heat.

Mustard plasters may be put to the heart, spine and shins. Stimulants are necessary, such as hot black coffee if possible or hot water, in which a small portion of brandy may be put. If brandy is not obtainable the patient may take aromatic spirits of ammonia in hot water every twenty minutes for a number of doses. In every case of shock a physician should be sent for immediately.

Dog Bites.--When a child is bit by a dog every effort should be made to get the dog. It should be kept in a safe place for a week so that it may be definitely known whether it is sick or not. If the dog dies within a few days after biting anyone it may be a.s.sumed that he had rabies. Its head should be sent to the local health authorities who can tell after examination if it was mad. If there is any reason to a.s.sume that the dog was infected, the child should receive the Pasteur treatment. This treatment will, if conducted under favorable circ.u.mstances, absolutely prevent hydrophobia.

The mother should sterilize the wound as thoroughly as possible. This may be done by using pure hydrogen peroxide. A little piece of absorbent cotton is wound round the end of a tooth-pick or match, dipped in the peroxide and the incision thoroughly rubbed clean. This may be done a number of times to ensure thorough cleansing. No effort should be made to cauterize the wound. It is not considered proper to employ this method with dog bites. When the physician examines the wound he may or may not open it further for more extensive inspection and sterilization.

Mothers should remember that there are thousands of bites by dogs that never cause any trouble, and if it is known that the dog is healthy no worry need trouble the family. It is also wrong to inform the child of the probability of hydrophobia. The child may worry himself sick with fear and if the mother is nervous and excitable he is apt to be made sick with the dread of what may follow. It is better, therefore, to remain quiet, to keep cool, and not to excite the little patient at all.