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The Home Medical Library

By

KENELM WINSLOW, B.A.S., M.D.

Formerly Assistant Professor Comparative Therapeutics, Harvard University; Late Surgeon to the Newton Hospital; Fellow of the Massachusetts Medical Society, etc.

With the Cooeperation of Many Medical Advising Editors and Special Contributors

IN SIX VOLUMES

First Aid :: Family Medicines :: Nose, Throat, Lungs, Eye, and Ear :: Stomach and Bowels :: Tumors and Skin Diseases :: Rheumatism :: Germ Diseases Nervous Diseases :: Insanity :: Sexual Hygiene Woman and Child :: Heart, Blood, and Digestion Personal Hygiene :: Indoor Exercise Diet and Conduct for Long Life :: Practical Kitchen Science :: Nervousness and Outdoor Life :: Nurse and Patient Camping Comfort :: Sanitation of the Household :: Pure Water Supply :: Pure Food Stable and Kennel

NEW YORK

The Review of Reviews Company

1907



Medical Advising Editors

Managing Editor

ALBERT WARREN FERRIS, A.M., M.D.

Former Assistant in Neurology, Columbia University; Former Chairman, Section on Neurology and Psychiatry, New York Academy of Medicine; Assistant in Medicine, University and Bellevue Hospital Medical College; Medical Editor, New International Encyclopedia.

Nervous Diseases

CHARLES E. ATWOOD, M.D.

Assistant in Neurology, Columbia University; Former Physician, Utica State Hospital and Bloomingdale Hospital for Insane Patients; Former Clinical Assistant to Sir William Gowers, National Hospital, London.

Pregnancy

RUSSELL BELLAMY, M.D.

Assistant in Obstetrics and Gynecology, Cornell University Medical College Dispensary; Captain and Assistant Surgeon (in charge), Squadron A, New York Cavalry; Assistant in Surgery, New York Polyclinic.

Germ Diseases

HERMANN MICHAEL BIGGS, M.D.

General Medical Officer and Director of Bacteriological Laboratories, New York City Department of Health; Professor of Clinical Medicine in University and Bellevue Hospital Medical College; Visiting Physician to Bellevue, St. Vincent's, Willard Parker, and Riverside Hospitals.

The Eye and Ear

J. HERBERT CLAIBORNE, M.D.

Clinical Instructor in Ophthalmology, Cornell University Medical College; Former Adjunct Professor of Ophthalmology, New York Polyclinic; Former Instructor in Ophthalmology in Columbia University; Surgeon, New Amsterdam Eye and Ear Hospital.

Sanitation

THOMAS DARLINGTON, M.D.

Health Commissioner of New York City; Former President Medical Board, New York Foundling Hospital; Consulting Physician, French Hospital; Attending Physician, St. John's Riverside Hospital, Yonkers; Surgeon to New Croton Aqueduct and other Public Works, to Copper Queen Consolidated Mining Company of Arizona, and Arizona and Southeastern Railroad Hospital; Author of Medical and Climatological Works.

Menstruation

AUSTIN FLINT, JR., M.D.

Professor of Obstetrics and Clinical Gynecology, New York University and Bellevue Hospital Medical College; Visiting Physician, Bellevue Hospital; Consulting Obstetrician, New York Maternity Hospital; Attending Physician, Hospital for Ruptured and Crippled, Manhattan Maternity and Emergency Hospitals.

Heart and Blood

JOHN BESSNER HUBER, A.M., M.D.

Assistant in Medicine, University and Bellevue Hospital Medical College; Visiting Physician to St. Joseph's Home for Consumptives; Author of "Consumption: Its Relation to Man and His Civilization; Its Prevention and Cure."

Skin Diseases

JAMES C. JOHNSTON, A.B., M.D.

Instructor in Pathology and Chief of Clinic, Department of Dermatology, Cornell University Medical College.

Diseases of Children

CHARLES GILMORE KERLEY, M.D.

Professor of Pediatrics, New York Polyclinic Medical School and Hospital; Attending Physician, New York Infant Asylum, Children's Department of Sydenham Hospital, and Babies' Hospital, N. Y.; Consulting Physician, Home for Crippled Children.

Bites and Stings

GEORGE GIBIER RAMBAUD, M.D.

President, New York Pasteur Institute.

Headache

ALONZO D. ROCKWELL, A.M., M.D.

Former Professor Electro-Therapeutics and Neurology at New York Post-Graduate Medical School; Neurologist and Electro-Therapeutist to the Flushing Hospital; Former Electro-Therapeutist to the Woman's Hospital in the State of New York; Author of Works on Medical and Surgical Uses of Electricity, Nervous Exhaustion (Neurasthenia), etc.

Poisons

E. ELLSWORTH SMITH, M.D.

Pathologist, St. John's Hospital, Yonkers; Somerset Hospital, Somerville, N. J.; Trinity Hospital, St. Bartholomew's Clinic, and the New York West Side German Dispensary.

Catarrh

SAMUEL WOOD THURBER, M.D.

Chief of Clinic and Instructor in Laryngology, Columbia University; Laryngologist to the Orphan's Home and Hospital.

Care of Infants

HERBERT B. WILCOX, M.D.

Assistant in Diseases of Children, Columbia University.



Special Contributors

Food Adulteration

S. JOSEPHINE BAKER, M.D.

Medical Inspector, New York City Department of Health.

Pure Water Supply

WILLIAM PAUL GERHARD, C.E.

Consulting Engineer for Sanitary Works; Member of American Public Health Association; Member, American Society Mechanical Engineers; Corresponding Member of American Institute of Architects, etc.; Author of "House Drainage," etc.

Care of Food

JANET MCKENZIE HILL

Editor, Boston Cooking School Magazine.

Nerves and Outdoor Life

S. WEIR MITCHELL, M.D., LL.D.

LL.D. (Harvard, Edinburgh, Princeton); Former President, Philadelphia College of Physicians; Member, National Academy of Sciences, Association of American Physicians, etc.; Author of essays: "Injuries to Nerves," "Doctor and Patient," "Fat and Blood," etc.; of scientific works: "Researches Upon the Venom of the Rattlesnake," etc.; of novels: "Hugh Wynne," "Characteristics," "Constance Trescott," "The Adventures of Francois," etc.

Sanitation

GEORGE M. PRICE, M.D.

Former Medical Sanitary Inspector, Department of Health, New York City; Inspector, New York Sanitary Aid Society of the 10th Ward, 1885; Manager, Model Tenement-houses of the New York Tenement-house Building Co., 1888; Inspector, New York State Tenement-house Commission, 1895; Author of "Tenement-house Inspection," "Handbook on Sanitation," etc.

Indoor Exercise

DUDLEY ALLEN SARGENT, M.D.

Director of Hemenway Gymnasium, Harvard University; Former President, American Physical Culture Society; Director, Normal School of Physical Training, Cambridge, Mass.; President, American Association for Promotion of Physical Education; Author of "Universal Test for Strength," "Health, Strength and Power," etc.

Long Life

SIR HENRY THOMPSON, Bart., F.R.C.S., M.B. (Lond.)

Surgeon Extraordinary to His Majesty the King of the Belgians; Consulting Surgeon to University College Hospital, London; Emeritus Professor of Clinical Surgery to University College, London, etc.

Camp Comfort

STEWART EDWARD WHITE

Author of "The Forest," "The Mountains," "The Silent Places," "The Blazed Trail," etc.



The Home Medical Library

Volume I

FIRST AID IN EMERGENCIES

By KENELM WINSLOW, B.A.S., M.D. (Harv.)

Formerly Assistant Professor Comparative Therapeutics, Harvard University; Late Surgeon to the Newton Hospital; Fellow of the Massachusetts Medical Society, etc.

ASSISTED BY

ALBERT WARREN FERRIS, A.M., M.D.

Former Assistant in Neurology, Columbia University; former Chairman, Section on Neurology and Psychiatry, New York Academy of Medicine; Assistant in Medicine, University and Bellevue Hospital Medical College; Medical Editor, "New International Encyclopedia"

GERM DISEASES

By KENELM WINSLOW, B.A.S., M.D. (Harv.)

NEW YORK

The Review of Reviews Company

1907



Copyright, 1907, by

THE REVIEW OF REVIEWS COMPANY

THE TROW PRESS, NEW YORK



Contents

PART I

CHAPTER PAGE

I. RESTORING THE APPARENTLY DROWNED 27

Reviving the Patient—How to Expel Water from the Stomach and Chest—Instructions for Producing Respiration—When Several Workers are at Hand—When One must Work Alone—How to Save a Drowning Person.

II. HEAT STROKE AND ELECTRIC SHOCK 39

First-aid Rules—Symptoms of Heat Exhaustion—Treatment of Heat Prostration—What to Do in Case of Electric Shock—Symptoms—Artificial Respiration—Mortality in Lightning Strokes.

III. WOUNDS, SPRAINS, AND BRUISES 50

Treatment of Wounds—Bleeding from Arteries and Veins—Punctured Wounds—Oozing—Lockjaw—Bruises— Abrasions—Sprains and Their Treatment—Synovitis— Bunions and Felons—Weeping Sinew—Foreign Bodies in Eye, Ear, and Nose.

IV. FRACTURES 80

How to Detect Broken Bones—Fracture of Rib and Collar Bone—Instructions for Applying Dressings—Bandage for Broken Jaw—Fracture of Shoulder-blade, Arm, Hip, Leg, and Other Bones—Compound Fractures.

V. DISLOCATIONS 118

Varieties of Dislocations—Method of Reducing a Dislocated Jaw—A Dislocated Shoulder—Indications when Elbow is Out of Joint—Dislocation of Hip, etc.—Forms of Bandages.

VI. ORDINARY POISONS 139

Unknown Poisons—Symptoms and Antidotes—Poisoning by Carbolic and Other Acids—Alkalies—Metal Poisoning—Aconite, Belladonna, and Other Narcotics—Chloral—Opium, Morphine, Laudanum, Paregoric, and Soothing Sirups—Tobacco, Strychnine, etc.

VII. FOOD POISONS 147

Poisons in Shellfish and Other Food—Symptoms and Remedies—How Bacteria are Nourished—Infected Meat and Milk—Treatment of Tapeworm—Trichiniasis—Potato Poisoning.

VIII. BITES AND STINGS 155

Country and City Mosquitoes—How Yellow Fever is Communicated—Treatment of Mosquito Bites—Bee, Wasp, and Hornet Stings—Lice—Fleas and Flies—Centipedes and Scorpions—Spiders—Poisonous Snakes—Cat and Dog Bites.

IX. BURNS, SCALDS, FROSTBITES, ETC. 171

General Rules for Treating Burns and Scalds—Hints on Dressings—Burns Caused by Acids and Alkalies—Remedies for Frostbite—Care of Blisters and Sores—Chilblains—Ingrowing Toe Nails—Fainting and Suffocation—Fits.

PART II

I. CONTAGIOUS MALADIES 191

Symptoms and Treatment of Scarlet Fever—Diagnosis—Duration of Contagion—Difference Between True and German Measles—Smallpox—Cure a Matter of Good Nursing—Chickenpox.

II. INFECTIOUS DISEASES 221

Typhoid Fever—Symptoms and Modes of Communication—Duration of the Disease—The Death Rate—Importance of Bathing—Diet—Remedies for Whooping Cough—Mumps—Erysipelas.

III. MALARIA AND YELLOW FEVER 247

Malaria Caused by Mosquitoes—Distribution of the Disease—Severe and Mild Types—Prevention and Treatment—Yellow Fever not a Contagious Disease—Course of the Malady—Watchful Care and Diet the only Remedies.



INDEX

To First Aid and General Topics

NOTE.—The Roman numerals I, II, III, IV, V, and VI indicate the volume; the Arabic figures 1, 2, 3, etc., indicate the page number.

Abrasions, I, 64

Abscess, alveolar, II, 58

Acids, burns by, I, 176, 177 poisoning by, I, 140

Acne, II, 145

Adenoids, II, 61

Adulterated food, tests for, V, 91

Adulteration of food, V, 87

Ague, I, 247 cake, I, 254

Air-bath, the, IV, 159

Albumen, IV, 262

Alcohol, use of, IV, 44, 153

Alcoholic drinks, IV, 153

Alcoholism, III, 47, 52

Algae, remedy for, V, 56

Alkalies, burns by, I, 177 poisoning by, I, 140

Amenorrhoea, III, 75

Anaemia, III, 174

Ankle, sprain of, I, 65, 67, 68

Ankle-joint fracture, I, 115

Antitoxin, II, 77

Apoplexy, III, 49

Appendicitis, III, 256

Arm, fracture of, I, 91

Arteries, systemic, III, 168

Artery, bleeding from an, I, 51, 52

Arthritis, II, 177

Artificial respiration, I, 28

Asthma, II, 104

Astigmatism, II, 26

Athletics, home, IV, 69

Auricles of the heart, III, 168

BABY, bathing the, III, 109 care of the, III, 108 clothing of the, III, 110 diet for the, III, 134 food for the, III, 132; IV, 261 nursing the, III, 114 teething, III, 113 temperature of the, III, 110 weaning the, III, 117 weighing the, III, 112

Bacteria, destruction of, V, 238-253 in food, I, 147-154 in soil, V, 135

Baldness, II, 167; IV, 21

BANDAGES, I, 133 forms of, I, 132, 134, 136, 137 for bruises, I, 62-64 for fractures, I, 83-117 for sprains, I, 65-72 for wounds, I, 51-61

Barley water, IV, 263

Bathing, indoor, IV, 19, 155 outdoor, IV, 16 in convulsions, III, 35 in malaria, I, 259 in pneumonia, II, 94 in scarlet fever, I, 197 in skin irritations, II, 140 in smallpox, I, 216 in typhoid fever, I, 231 in yellow fever, I, 266

BATHS, cold, IV, 15 foot, IV, 157 hot, IV, 19, 156 tepid, IV, 19 Turkish, IV, 20, 159 warm, IV, 19

Bed sores, I, 233

Bed-wetting, II, 213

Bee stings, I, 158

Beef, broth, IV, 261 juice, IV, 262 parts of, IV, 198 scraped, IV, 262 tea, IV, 261

Bellyache, III, 247

Bilious fever, I, 247

Biliousness, III, 184

BITES, cat, I, 170 dog, I, 170 flea, I, 162 fly, I, 164 lice, clothes, I, 161 lice, crab, I, 162 lice, head, I, 160 mosquito, I, 155 snake, I, 166 spider, I, 164 tarantula, I, 164 wood tick, I, 159

Black eye, II, 14

Blackheads, II, 145

Black water fever, I, 256

Bladder, inflammation of the, II, 215 stone in the, III, 264

BLEEDING, from an artery, I, 51, 52 from a vein, I, 51, 52 from punctured wounds, I, 52, 53 from the lungs, I, 62 from the nose, I, 61 from the scalp, I, 60 from the stomach, I, 62 from the womb, III, 82

Blood, deficiency of, III, 174 oozing of, I, 54

Bloody flux, III, 222

Boils, II, 157

Bottles, milk, III, 128

Bowel, prolapse of the, III, 143

BOWELS, catarrh of the, III, 205 diseases of the, III, 205 inflammation of the, III, 252 obstruction of the, III, 268 passages from the, IV, 247

Bowleg, III, 162

Brain, anatomy of the, III, 22 arteries of the, III, 22 autopsies of the, II, 230

Breasts, care of, after childbirth, III, 105 inflammation of the, III, 140

Breath, holding the, III, 153

Breathing, how to test the, IV, 248 to produce artificial, I, 28, 34, 43, 178, 186

Bright's disease, acute, II, 220 chronic, II, 222

BROKEN BONE, I, 80 ankle, I, 115 arm, I, 91 collar bone, I, 85 finger, I, 101 forearm, I, 94 hand, I, 101 hip, I, 104 how to tell a, I, 80 jaw, I, 89 kneepan, I, 109 leg, I, 111 rib, I, 83 shoulder blade, I, 91 thigh, I, 106 wrist, I, 99

Bronchial tubes, diseases of the, II, 87

Bronchitis, II, 88, 91

Broth, beef, IV, 261 chicken, IV, 261 clam, IV, 263 mutton, IV, 261 oyster, IV, 267 veal, IV, 261

BRUISES, bandages for, I, 63 treatment of, I, 62, 63

Bunion, I, 72

BURNS, I, 171 about the eyes, II, 16 from acids, I, 176 from alkalies, I, 177 from electric shock, I, 45 first class, I, 172 second class, I, 172 third class, I, 173 severe, I, 174

Callus of the skin, II, 156

Camp comfort (See Contents VI)

Camp cookery (See Contents VI)

Camp cure (See Contents VI)

CAMPING, in the North Woods, VI, 195 in the Western Mountains, VI, 214 outfit, VI, 212

Cancer, II, 123 of the breast, II, 124 of the lip, II, 125 of the stomach, II, 125 of the womb, II, 125

Canker, II, 68

Capillaries, systemic, III, 168

Carbuncle, II, 161

Carotid arteries, III, 22

Catarrh, II, 41, 54, 55 of the bowels, III, 205 effect of, on the ears, II, 38, 41 of the stomach, III, 185

Catarrhal deafness, II, 39 inflammation of eye, II, 18

Cat bite, I, 170

Catheter, how to use a, II, 219; IV, 252

Centipede sting, I, 164

Cereals as food, IV, 35, 229

Cerebellum, III, 22

Cerebral arteries, III, 22

Chafing, II, 142

Chagres fever, I, 256

Change of life, III, 70

Chapping, II, 142

Chicken broth, IV, 261

Chickenpox, I, 217

Chilblains, I, 182

Childbed fever, III, 107

Childbirth, after-pains in, III, 105 articles needed during, III, 96 bleeding after, III, 86 care after, III, 103 care in, III, 98

CHILDREN, DISEASES OF, III, 140 adenoids, II, 61 bed-wetting, II, 213 bowel, prolapse of the, III, 143 bowels, catarrh of the, III, 209 bowleg, III, 162 breath, holding the, III, 153 breasts, inflammation of the, III, 140 chickenpox, I, 217 cholera infantum, III, 211 chorea, III, 155 colic, III, 267 constipation, III, 238 convulsions, III, 34 cord, bleeding of the, III, 142 cough, II, 91 croup, II, 83 diarrhea, III, 208, 209 diphtheria, II, 77 dysentery, III, 213 epilepsy, III, 39 earache, II, 48 fever, III, 146 food for, III, 132-139 foreskin, adhering, III, 141 glands, enlarged, III, 149 hip disease, III, 161 holding the breath, III, 153 knock knees, III, 163 larynx, spasm of the, III, 153 measles, I, 198 German measles, I, 203 membranous croup, II, 79 milk poisoning, III, 209, 211 mumps, I, 235 navel, sore, III, 142 pains, growing, III, 146 Pott's disease, III, 157 rickets, III, 151 ringworm, II, 149 rupture, II, 128 scarlatina, I, 192 scarlet fever, I, 192 scrofula, III, 149 scurvy, II, 182 sore mouth, II, 65 spine, curvature of the, III, 157, 159 St. Vitus's Dance, III, 155 stomach, catarrh of the, III, 209 urine, painful passage of, III, 141 urine, retention of, III, 141 wasting, III, 144 whooping cough, I, 238 worms, III, 240

Chills and fever, I, 247

Cholera, III, 228 infantum, III, 211 morbus, III, 226

Chorea, III, 158

Cinder in the eye, I, 176; II, 13

Circulation, the, III, 168

Circumcision, III, 142

Clam broth, IV, 263

Climacteric, the, III, 70

Clothing, proper, IV, 22

Cochlea, II, 46

Coffee, use of, IV, 43

Cold, exposure to, I, 181 in the head, II, 55 sore, II, 147

COLIC, III, 247 gallstone, III, 261 in babies, III, 267 intestinal, III, 249 mucous, III, 219 renal, III, 263

Collar-bone fracture, I, 85

Complexion, the, IV, 20

Confinement, III, 97

Congestion of the eyelid, II, 17

Conjunctivitis, II, 16, 18

Constipation, in adults, III, 233 in children, 238

Consumption, II, 96 fresh-air treatment for, II, 102 outdoor life for, VI, 72 prevention of, II, 104

Contagion, in cholera, 229 in conjunctivitis, II, 19 in diphtheria, II, 80 in eruptive fever, I, 191-220 in gonorrhea, II, 199 in grippe, II, 108 in mumps, I, 236 in syphilis, II, 206, 209 in whooping cough, I, 238

CONTAGIOUS DISEASES, I, 191

Convalescence (See Contents VI)

Convulsions, in children, III, 34 in adults, I, 188

COOKING (See Contents IV) baking, IV, 171 boiling, IV, 180 braising, IV, 182 broiling, IV, 172 camp, VI, 220 cereals, IV, 229 eggs, IV, 184 entrees, IV, 219 fish, IV, 188 frying, IV, 175 game, IV, 202 poultry, IV, 202 roasting, IV, 171 sauces, IV, 216 sauteing, IV, 174 shellfish, IV, 195 soups, IV, 207 stewing, IV, 181 time of, IV, 177 utensils, IV, 232 vegetables, IV, 223

Copper sulphate method, V, 52

Copper vessels, use of, V, 67

Cord, bleeding of the, III, 142

Corns, II, 154

Costiveness, III, 233

COUGH, acute, II, 87, 91 whooping, I, 238

Cricoid cartilage, II, 70

Cross eye, II, 33

Croup, membranous, II, 79 ordinary, II, 83, 92

Curvature of the spine, III, 157, 159

Cystitis, II, 215

Dandruff, II, 167

Deafness, catarrhal, II, 39 chronic, II, 36 temporary, II, 33

Delirium tremens, III, 50

DIARRHEA, acute, III, 205 chronic, III, 217 of children, III, 208, 209

DIET, IV, 26, 107, 123, 138, 153 animal, IV, 39 details of, IV, 146 errors of, IV, 107 for babies, III, 132 for brain workers, IV, 126 for long life, IV, 107 for the aged, IV, 112 proper, IV, 138 relation to climate, IV, 108 rules for, IV, 110, 123 simplicity of, IV, 138 vegetable and animal, IV, 39

Digestion, effect of dress on, IV, 42 hygiene of, IV, 26 processes of, IV, 28

Diphtheria, II, 77

DISINFECTANTS, chemical, V, 243 physical, V, 240 solutions for, V, 247

Disinfection, V, 238 of rooms, V, 249

DISLOCATIONS, elbow, I, 125 hip, I, 129 jaw, I, 118, 120 knee, I, 119 shoulder, I, 122

Dog bite, I, 170

Doses of drugs, IV, 255

Dressings, for bruises, I, 63, 64 for wounds, I, 53, 57 surgical, I, 131

Drink, nutritious, IV, 118

Drinking, steady, III, 52

DROWNED, arousing the, I, 27 producing respiration in the, I, 28, 34 restoring the, I, 27 saving the, I, 36

Drowning person, death grasp of a, I, 37 saving a, I, 36 swimming to relief of a, I, 36

Drugs, doses of, IV, 255

Drum membrane, II, 33, 43, 45, 46, 48

Dysentery, in adults, III, 222 in children, III, 213

Dysmenorrhea, III, 71

DYSPEPSIA, III, 185 causes of, IV, 27 nervous, III, 190

EAR, anatomy of the, II, 33, 37, 46 diseases of the, II, 33 foreign bodies in the, I, 78; II, 39 water in the, II, 42 wax in the, II, 35

Earache, II, 40 moderate, II, 48

Eating, proper mode of, IV, 140-149

Eczema, II, 163 climatic, II, 164 occupation, II, 164 seborrheic, II, 164, 165, 167

Eggnog, IV, 268

Eggs, as food, IV, 33, 184 soft-boiled, IV, 266

Egg water, IV, 262

Elbow, dislocation of, I, 125

ELECTRIC SHOCK, I, 43, 46

Enteric fever, I, 221

Enteritis, catarrhal, III, 205

Entero-colitis, III, 209

Enteroptosis, IV, 43

Environment, importance of, III, 65

Epiglottis, II, 70

Epilepsy, III, 39 spasms in, III, 39 without spasms, III, 40

Erysipelas, I, 244

Eustachian tube, II, 37, 38, 41, 46, 49, 50

Exhaustion, mental and nervous, VI, 91-145

EXERCISE, IV, 48, 66 corrective, IV, 57 effect of, IV, 51 excessive, IV, 52 for all-round development, IV, 59, 101 for boyhood, IV, 69 for children, IV, 67 for elderly men, IV, 79 for everyone, IV, 66 for girls, IV, 73 for middle-aged men, IV, 77 for women, IV, 76 for young men, IV, 71 for youth, IV, 69 home, IV, 57 regular, IV, 53, 58 results of, IV, 98 without apparatus, IV, 57

EYE, anatomy of the, II, 30 astigmatism of the, II, 26 black, II, 14 catarrhal inflammation of the, II, 18 cinder in the, I, 76 cross, II, 33 diseases of the, II, 13 farsighted II, 21 foreign bodies in the, I, 76; II, 13 hyperopic, II, 22 lens of the, II, 30 muscles of the, II, 30 nearsighted, II, 25 pink, II, 19 retina of the, II, 30 sore, II, 16 strain, II, 21 wounds and burns of the, II, 16

Eyelid, congestion of the, II, 17 stye on the, II, 15 twitching of the, II, 15

Eye muscles, weakness of the, II, 28

Eye-strain, II, 21

Facial, neuralgia, III, 28 paralysis, III, 25

FAINTING, I, 185; III, 45

Farsightedness, II, 21

Fat as a food, IV, 35

Fatigue, causes of, IV, 50

Felon, I, 74, 75

FEVER, bilious, I, 247 black water, I, 256 Chagres, I, 256 chills and, I, 247 enteric, I, 221 gastric, III, 179 intermittent, I, 247 marsh, I, 247 remittent, I, 247 rheumatic, II, 169 scarlet, I, 192 swamp, I, 247 typhoid, I, 221 yellow, I, 261

Fever blister, II, 147

Fevers, eruptive contagious, I, 191

Fish as food, IV, 188

Finger, fracture of, I, 101

FIT, I, 188

Flea bites, I, 162

Fly bites, I, 164

Food, adulteration of, V, 87 containing parasites, I, 152 elements of, IV, 29 for babies, III, 132; IV, 261 for the sick, IV, 261 infected, I, 150 laws, V, 88 poisoning, I, 147 preparation of, IV, 171 pure, selection of, V, 89

Foods, advertised, IV, 116

Foot gear, IV, 24

Forearm fracture, I, 94

FOREIGN BODIES, in the ear, I, 78; II, 39 in the eye, I, 76; II, 13 in the nose, I, 79; II, 53

Foreskin, adhering, III, 141

Fourth-of-July accidents, I, 56

FRACTURE (See Broken Bone) Colles', I, 99 compound, I, 80, 116 how to tell a, I, 81 simple, I, 80

Freckles, II, 150

Freezing, I, 178

FROSTBITE, I, 178, 180

Gallstone colic, III, 261

Ganglion, I, 75

Garbage, disposal of, V, 171

Gastric fever, III, 179

Genito-urinary diseases, II, 199

Germs (See Bacteria)

Girls, exercises for, IV, 73 physical training for, IV, 72; VI, 39

Glands, enlarged, III, 149

Gonorrhea, II, 199 in women, II, 203; III, 90

Gout, common, II, 183 rheumatic, II, 177

Grippe, la, II, 56, 108

Growing pains, III, 146

Hair, the, IV, 21

Hallucinations, II, 232

Hand, anatomy of the, III, 30 arteries of the, III, 30 fracture of the, I, 101 nerves of the, III, 30 tendons of the, III, 30

HEADACHE, constant, II, 120 due to disease, II, 117 due to eye strain, II, 29 due to heat stroke, II, 120 due to indigestion, II, 115 due to poisoning, II, 118 nervous, II, 117 neuralgic, II, 117 sick, II, 113 sympathetic, II, 116

Head gear, IV, 24, 160

Head injuries, III, 46

HEART, anatomy of the, III, 167, 168 enlargement of the, III, 169 palpitation of the, III, 171

Heart disease, III, 167

Heat exhaustion, I, 39, 40

Heating, cost of, V, 254 methods of, V, 161

HEAT STROKE, I, 39, 41

Hemorrhage (See Bleeding)

Hemorrhoids, II, 135

Heredity, III, 57 in consumption, II, 97

Hernia, II, 128 (See Rupture) strangulated, II, 129 umbilical, II, 128 ventral, II, 128

Hiccough or hiccup, III, 21

Hip disease, III, 161

Hip, dislocation of, I, 129 fracture of, I, 104

Hives, II, 143

Hoarseness, II, 80

Hornet stings, I, 158

"Horrors," the, III, 50

House, proper construction of, V, 141

Housemaid's knee, I, 72

Hypodermic syringe, the, IV, 250

Hysteria, VI, 20

INDIGESTION, acute, III, 178 a result of errors, IV, 130 chronic, III, 185 intestinal, III, 202 not disease, IV, 134

Infants, bathing, III, 109 care of, III, 108 clothing for the, III, 110 feeding of, III, 118

Infection, V, 238 in erysipelas, I, 244 in malaria, I, 247 in typhoid fever, I, 221 in yellow fever, I, 261

INFECTIOUS DISEASES, I, 221

Influenza, II, 108

Ingrowing toe nail, I, 184

Injections, III, 238, 239

INJURED, CARRYING THE, I, Frontispiece

Insane, criminal, II, 234 delusions of the, II, 233 illusions of the, II, 231 sanitariums for the, II, 245

Insanity, II, 229; VI, 164 causes of, II, 239 false ideas regarding, II, 241 physical signs of, II, 235 prevention of, II, 240 types of, II, 236

Insensibility, III, 44

Insomnia, III, 23

Intermittent fever, I, 247

Invalids, care of, VI, 155

Itching, II, 139

Ivy poison, II, 152

Jaundice, III, 180

Jaw, dislocation of, I, 118, 120 fracture of, I, 89

Joint, injury of a, I, 65, 69

Junket, IV, 266

Kerosene, extermination of mosquitoes by, V, 77

Kidneys, inflammation of the, II, 220 Bright's disease of the, II, 219 stone in the, III, 265

Knee, dislocation of, I, 119 sprain of, I, 67, 70

Kneepan fracture, I, 109

Knock knees, III, 163

Laryngitis, II, 80

Larynx, anatomy of the, II, 70 spasm of the, III, 153

Leeches, use of, II, 43

Leg bones, fracture of, I, 111, 116

Leucorrhoea, III, 86

Lice, body, I, 161 clothes, I, 161 crab, I, 162 head, I, 160

Life-saving service, U. S., I, 27

Lightning stroke, I, 43

Limewater, IV, 268

LOCKJAW, I, 56

Long life, rules for (See Contents IV, Part III)

Lotions, II, 145, 151, 152, 155, 166

Lues, II, 206

Lumbago, II, 173

LUNGS, bleeding from the, I, 62 diseases of the, II, 87 inflammation of the, II, 93 tuberculosis of the, II, 96

MALARIA, I, 247 chronic, I, 253 mosquito as cause of, I, 157, 247 pernicious, I, 255 remittent, I, 254

Malt soup, IV, 267

Marasmus, III, 144

Marketing, hints on, IV, 232

Marriage relations, II, 197

Marsh fever, I, 247

Measles, common, I, 198 German, I, 203

Meat as food, IV, 32

Median nerve, III, 30

Medicine chest, contents of the, IV, 243

MEDICINES, PATENT, II, 245 antiphlogistine, II, 258 belladonna plasters, II, 257 dangers of, II, 260 hamamelis, II, 255 headache powders, II, 262 Listerine, II, 256 Platt's Chlorides, II, 259 Pond's Extract, II, 255 proprietary, II, 246 Scott's Emulsion, II, 257 vaseline, II, 254 witch-hazel, II, 255

Medulla oblongata, III, 22

Membranous croup, II, 79

Menopause, the, III, 70

Menstruation, III, 67 absence of, III, 75 arrest of, III, 79 cessation of, III, 78 delayed, III, 79 painful, III, 71 scanty, III, 79

Metals, poisoning by, I, 141

Miliaria, II, 148

MILK, as food, IV, 33 curd, IV, 266 mixtures, III, 124 peptonized, IV, 264 poisoning, III, 209, 211 porridge, IV, 267

Mind cure, VI, 31 disorder of the, II, 229

Miscarriage, danger of, III, 80

MOSQUITO bites, I, 155, 158; V, 71 destruction of the, I, 258; V, 75 exterminating the, V, 70 malaria due to the, I, 248 yellow fever due to the, I, 261; V, 70

Motor nerve, III, 38

Mouth-breathing, II, 60

Mouth, inflammation of the, II, 64 sore, II, 64

Mumps, I, 235

Muscular action, IV, 48 development, by will power, IV, 63

MUSHROOM POISONING, V, 112

Mushrooms, edible, V, 115 how to tell, V, 114 poisonous, V, 124

Mutton broth, IV, 261

Myalgia, II, 173

Myopia, II, 25

Narcotics, poisoning by, I, 142

Nasal cavity, II, 54

Navel, sore, III, 142

Nearsightedness, II, 25

Nervous debility, III, 13 diseases, III, 13 exhaustion, III, 13; VI, 70, 167

NERVOUSNESS (See Contents VI) remedy for, VI, 70, 167; III, 20

Nervous system, reflex action of the, III, 38

Nettlerash, II, 143

Neuralgia, III, 27 facial, III, 28 of the chest, III, 29

Neurasthenia, III, 13

NOSE, anatomy of the, II, 54 bleeding from the, II, 51 catarrh of the, II, 55 diseases of the, II, 51 foreign bodies in the, I, 79; II, 53 obstructions in the, II, 60 septum of the, II, 51, 54, 61

Nosebleed, I, 61; II, 51

Nostrum, II, 248

Nurse and patient (See Contents VI)

Nurse, selection of the, VI, 150

Nursing, VI, 146

Oatmeal water, IV, 263

Olfactory nerves, III, 22

Oozing of blood, I, 54, 55

Optic nerves, III, 22

OUTDOOR LIFE (See Contents VI) for consumption, VI, 72 for nervous exhaustion, VI, 70, 167

Overworked, hints for the, VI, 91

Oyster broth, IV, 267

Palmar arch, III, 30

Pains, growing, III, 146

Palpitation of the heart, III, 171

Paralysis, facial, III, 25

Paranoia, II, 237

Parasites, malarial, I, 247 yellow fever, I, 261

Paresis, II, 237

Patent medicines, II, 247

Peritonitis, III, 252

Petit mal, III, 40

Pharyngitis, II, 69

Phthisis, II, 96

Pigeon breast, II, 63

Piles, external, II, 135 internal, II, 136

Pimples, II, 145

Pink eye, II, 19

Plumbing, connections, V, 194 defects in, V, 231 drains, V, 206 fixtures, V, 216 joints, V, 194 pipes, V, 191, 206 tests, 233 traps, V, 198

Pneumonia, II, 93

POISONING (See Poisons) by canned meats, I, 150 by fish, I, 148 by meat, I, 148, 150, 151 by milk, I, 148, 150, 151 food, bacterial, I, 147 food, containing parasites, I, 152 food, infected, I, 150 mushroom, V, 112 potato, I, 154

Poison ivy, II, 152

POISONS, acetanilid, I, 146 acid, carbolic, I, 140 acid, nitric, I, 140 acid, oxalic, I, 140 acid, sulphuric, I, 140 acids, I, 140 aconite, I, 142 alcohol, I, 143 alkalies, I, 140 ammonia, I, 141 antidotes, I, 139 antimony, I, 142 arsenic, I, 141 belladonna, I, 142 bichloride of mercury, I, 141 blue vitriol, I, 141 bug poison, I, 141 camphor, I, 142 caustic soda, I, 141 chloral, I, 143 cocaine, I, 145 copper, I, 141 corrosive sublimate, I, 141 digitalis, I, 142 ergot, I, 142 Fowler's solution, I, 141 headache powders, I, 146 hellebore, I, 142 ivy, II, 152 knockout drops, I, 143 laudanum, I, 144 lobelia, I, 142 lye, I, 141 matches, I, 142 mercury, I, 141 metals, I, 141 morphine, I, 144 narcotics, I, 142 nux vomica, I, 145 opium, I, 144 paregoric, I, 144 Paris green, I, 141 phenacetin, I, 146 phosphorus, I, 142 potash, I, 141 "rough on rats," I, 141 silver nitrate, I, 141 sleeping medicines, I, 143 soothing sirup, I, 144 strychnine, I, 145 tartar emetic, I, 142 tobacco, I, 144 unknown, I, 139 verdigris, I, 141 washing soda, I, 141 white precipitate, I, 141

Polypi, II, 54, 62

Pons Varolii, III, 22

Pott's disease, III, 157

Poultry as food, IV, 201

Pox, II, 206

Pregnancy, III, 91 diet during, III, 91 exercise during, III, 91 mental state during, III, 95 signs of, III, 80, 93

Prickly heat, II, 148

Proprietary medicines, II, 248

Pruritus, II, 139

Pulse, how to feel the, IV, 247

Punctured wound, bleeding from, a, I, 52, 53

Pure food bill, II, 249

PURE FOOD, SELECTION OF, V, 89-111 canned articles, V, 107 cereals, V, 98 chocolate, V, 107 cocoa, V, 107 coffee, V, 104 flavoring extracts, V, III meat, V, 92 meat products, V, 95 olive oil, V, 110 shellfish, V, 94 spices, V, 108 sugar, V, 108 tea, V, 104 vegetables, V, 96 vinegar, V, 110

Purifying water supply, V, 52

Quinsy, II, 75

Radial nerve, III, 30

Recipes, for babies, IV, 261 for the sick, IV, 261

Reflex action illustrated, III, 38; IV, 49

Remittent fever, I, 247

Renal colic, III, 263

Respiration, to produce artificial, I, 28, 34, 43, 178, 186

Respirations, counting the, IV, 248

Rest cure, III, 20

Reversion, III, 59

Rheumatic fever, II, 169 gout, II, 177

RHEUMATISM, acute, II, 169 chronic, II, 175 effect on the heart, II, 170 inflammatory, II, 169 muscular, II, 173 of the chest, II, 174

Rhinitis, II, 77

Rib, broken, I, 83

Rice water, IV, 264

Rickets, III, 151

Ringworm, of body, II, 149 of scalp, II, 149

RUN-AROUND, I, 73

Rupture, II, 128

Salt rheum, II, 163

Sanitariums for the insane, II, 245

SANITATION (See Contents V)

Sarcoma, II, 124

SCALDS, I, 171

Scalp wounds, I, 60

Scarlatina, I, 192

Scarlet fever, I, 192

Sciatica, III, 31

Scorpion sting, I, 164

Scrofula, III, 149

Scurvy, common, II, 180 infantile, II, 182

Seasickness, III, 195

Self-abuse, II, 192

Semicircular canals, II, 46

Sensory nerve, III, 38

Septum, II, 54 deviation of the, II, 60

Serum, antivenomous, I, 169

Sewage, V, 170 disposal of, V, 172

Sewer gas, V, 187

Sewers, V, 182

Sexual organs, care of the, II, 191 diseases of the, II, 199

Sexual relations, II, 194

Shingles, III, 29

Shoulder, dislocation of, I, 122 sprain of, I, 67

Shoulder-blade fracture, I, 91

Sick, food for the, IV, 261

Sick room, the, VI, 150

SKIN, callus of the, II, 156 chafing of the, II, 142 chapping of the, II, 142 cracks in the, II, 156 discolorations of the, II, 150 diseases of the, II, 139 irritation of the, II, 142 itching of the, II, 139

Sleeplessness, III, 23

Sling, how to make a, 87, 88

Smallpox, I, 206

Snake bite, I, 166, 168

Soap, use of, IV, 32

Soil, bacteria in, V, 135 constituents of, V, 131 contamination of, V, 136 diseases due to, V, 139

Soil, improving the, V, 140 influence of, V, 137

Sore mouth, aphthous, II, 66 gangrenous, II, 67 simple, II, 65 ulcerous, II, 67

Sore eyes, II, 16

Sore throat, II, 69

Soup, malt, IV, 267

Soups, IV, 207

Spider bite, I, 164, 165

Spinal cord, III, 38

Spine, curvature of, III, 157, 159

Spleen, enlargement of, II, 254

Splinters, removing, I, 54

Splints, I, 61, 71, 93, 97, 102, 107, 110, 111, 114, 128

SPRAINS, bandages for, I, 65, 67 treatment of, 65, 66

Sprue, II, 66

Squint, II, 33

St. Vitus's Dance, III, 155

Stiff neck, II, 174

STINGS, bee, I, 158 centipede, I, 164 hornet, I, 158 scorpion, I, 164 wasp, I, 158

Stitching a wound, I, 58

STOMACH, bleeding from the, I, 62 catarrh of the, III, 185, 209 diseases of the, III, 178 neuralgia of the, III, 251

Stomachache, III, 247

Stone, in the bladder, III, 265 in the kidney, III, 263

Strabismus, II, 33

Stye, II, 15

SUFFOCATION, from gas, I, 186

Sunstroke, I, 40

Surgical dressings, I, 131

Swamp fever, I, 247

SYNOVITIS, I, 69

Syphilis, II, 206, 212

Syringe, the bulb, III, 239 the fountain, III, 238 the hypodermic, IV, 250

Tan, II, 150

Tapeworm, I, 152

Tarantula bite, I, 164

Tea, use of, IV, 43

Teeth, artificial, IV, 119 care of the, IV, 26

Teething, III, 113

Temperature, how to tell the, IV, 246 proper, IV, 161, 162

Tetter, II, 163

Thermometer, clinical, use of the, IV, 246

Thigh-bone fracture, I, 106

THROAT, diseases of the, II, 51, sore, II, 69

Thrush, II, 66

Tic douloureux, III, 28

Toe nail, ingrowing, I, 184

Tongue, noting appearance of the, IV, 249

Tonsilitis, II, 71

Tonsils, enlarged, II, 63

Tooth, ulcerated, II, 58

Toothache, II, 58

Training, physical, IV, 124; VI, 38

Trichiniasis, I, 153

Truss, use of the, II, 130

Tuberculin, II, 101

Tuberculosis of the bones, III, 157 of the lungs, II, 96

TUMORS, II, 123

Turbinates, enlarged, II, 60

Typhoid fever, I, 221 complications of, I, 228

Ulcerated tooth, II, 58

Ulnar nerve, III, 30

UNCONSCIOUSNESS, III, 44 due to drunkenness, III, 47 due to epilepsy, III, 48 due to fainting, III, 45 due to head injuries, III, 46

Unconsciousness, due to kidney disease, III, 48 due to opium poisoning, III, 48 due to sunstroke, III, 48

Underclothing, proper, IV, 22

URINE, incontinence of, II, 213 involuntary passage of, II, 213 painful passage of, III, 141 retention of, II, 218; III, 141 stoppage of, II, 218 suppression of, II, 218

Urticaria, II, 143

Vaccination, I, 211-215

Varicocele, II, 134

Varicose veins, II, 132

Varioloid, I, 211

Veal broth, IV, 261

Vegetables as food, IV, 34, 223

Vein, bleeding from a, I, 51, 52

Veins, systemic, III, 168

VENTILATION, artificial, V, 157 forces of, V, 148 methods of, V, 150 natural, V, 151

Ventricles of the heart, III, 168

Vision, defects of, II, 21-33

Vocal cords, II, 70

VOMITING, III, 194 of blood, III, 200 of indigestion, III, 199 of pregnancy, III, 196

Wakefulness, III, 23

Warming, V, 160

Warts, flat, II, 154 moist, II, 154 seed, II, 153 threadlike, II, 153

Wasp stings, I, 158

Wasting, III, 144

WATER, barley, IV, 263 egg, IV, 262 lake, V, 27 lime, IV, 268 oatmeal, IV, 263 pure, V, 21, 52 rain, V, 26 rice, IV, 264 spring, V, 29 well, V, 31-37 wheat, IV, 264

Water cure, for nervous exhaustion, III, 20

Water distribution, V, 39 engines for, V, 42 hydraulic rams for, V, 40 pressure systems for, V, 47 storage tanks for, V, 46 windmills for, V, 41

Water supply, laws of, V, 37 plants which pollute, V, 54 pollution of, V, 22 purifying the, V, 52 sources of, V, 19 system for country, V, 47

Wax in the ear, II, 34

Wear and tear (See Contents VI)

Weaning, III, 117

WEEPING SINEW, I, 75

Wen, II, 126

Wheat water, IV, 264

Whey, mixtures, IV, 265 wine, IV, 266

Whites, III, 87

Whitlow, I, 74, 75

Whooping cough, I, 238

Womb, hemorrhage from the, III, 82

Women, exercises for, IV, 76

Wood tick, bite of, I, 159

WORMS, pin, III, 243 round, III, 242 tape, III, 245

WOUNDS, I, 50 about the eyes, II, 16 caused by pistols, I, 56 caused by firecrackers, I, 56 cleansing, I, 59 foreign bodies in, I, 54, 56 scalp, I, 60 stitching, I, 58 treatment of, I, 50, 57

Wrist, fracture of the, I, 99 sprain of the, I, 65, 67

Yellow fever, I, 261 mosquito as cause of, I, 157, 261, 265



Preface

Medicine, as the art of preserving and restoring health, is the rightful office of the great army of earnest and qualified American physicians. But their utmost sincerity and science are hampered by trying restrictions with three great classes of people: those on whom the family physician cannot call every day; those on whom he cannot call in time; and those on whom he cannot call at all.

To lessen these restrictions, thus assisting and extending the healer's work, is the aim of the pages that follow.

Consider first the average American household, where the family physician cannot call every day. Not a day finds this household without the need of information in medicine or hygiene or sanitation. More efforts of the profession are thwarted by ignorance than by epidemic. Not to supplant the doctor, but to supplement him, carefully prepared information should be at hand on the hygiene of health—sanitation, diet, exercise, clothing, baths, etc.; on the hygiene of disease—nursing and sick-room conduct, control of the nervous and insane, emergency resources, domestic remedies; above all, on the prevention of disease, emphasizing the folly of self-treatment; pointing out the danger of delay in seeking skilled medical advice with such troubles as cancer, where early recognition may bring permanent cure; showing the benefit of simple sanitary precautions, such as the experiment-stations method of exterminating the malaria-breeding mosquito. The volumes treating of these subjects cannot be made too clear, nontechnical, fundamental, or too well guarded by the supervision of medical men known favorably to the profession.

Again, the physician cannot come on time to save life, limb, or looks to the victim of many a serious accident. And yet some bystander could usually understand and apply plain rules for inducing respiration, applying a splint, giving an emetic, soothing a burn or the like, so as to safeguard the sufferer till the doctor's arrival—if only these plain rules were in such compact form that no office, store, or home in the land need be without them.

Finally, the doctor cannot come at all to hundreds of thousands of sailors, automobilists, and other travelers, to ranchers, miners, and country dwellers of many sorts. This third class has had, hitherto, little choice between some "Practice of Medicine," too technical to be helpful, on the one hand, and on the other, the dubious literature of unsanctioned "systems"; or the startling "cure-all" assertions emanating from many proprietors of remedies; or "Complete Family Physicians," which offer prescriptions as absurd for the layman as would be dynamite in the hands of a child, with superfluous and loathsome pictures appealing only to morbid curiosity, and with a general inaccuracy utterly out of touch with twentieth-century knowledge. What such people need, much more than the dwellers in settled communities, is to learn the views of modern medicine upon the treatment of the ever-present common ailments—the use of standard remedies, cautions against the abuse of narcotics, lessons of discrimination against harmful, useless, or expensive "patent medicines," and proper rules of conduct for diet, nursing, and general treatment.

Authentic health literature existed abundantly before the preparation of these volumes, but it was scattered, expensive, and in most cases not arranged for the widest use. Not within our knowledge has the body of facts, most helpful to the layman on Sanitation and Hygiene, First Aid, and Domestic Healing, been brought together as completely, as clearly, as concisely, with a critical editing board so qualified, and with special contributions so authoritative as this work exhibits.

"Utmost caution" has been a watchword with the editors from the start. Those to whom the doctor cannot come every day have been repeatedly warned of the follies of self-treatment, and reminded that to-day it is the patient that is treated—not the disease. Those to whom the doctor cannot come in time are likewise warned that the "First-aid Rules" of this Library are for temporary treatment only, in all situations where it is possible to get a physician. And the utmost conservatism has been striven for by the author and the several revisers in every part of the work that appeals particularly to dwellers in localities so removed that the doctor cannot come at all. Especial delicacy was also sought in the treatment of a chapter which, it is hoped, will aid parents to guide their children in sexual matters. The illustrations represent helpful, normal conditions (with the exception of some necessary representations of fracture, etc.) with instructive captions aimed to make them less a sensation than a real benefit; and no pictures appear of a sort to stimulate mere morbid curiosity.

The greatest sympathy and appreciation of this work have been shown by the progressive and recognized practitioners who have seen early copies. They recognize it as a timely attempt to create and compile health literature in a form most complete within its limits of space, and in a manner most helpful and sane. The eager curiosity regarding themselves that has been sweeping over the American people has been diverted into frivolous and harmful channels by much reckless talk and writing. A prominent newspaper, in its Sunday editions, recently took up the assertion, in a series of articles, that appendicitis operations resulted from a gigantic criminal conspiracy on the part of surgeons; that a sufficient cure for appendicitis, "as any honest doctor would tell you," is an injection of molasses and water! The endless harm done by such outright untruth is swelled by a joining stream of slapdash misinformation and vicious sensation, constantly running through the press.

Education is sorely needed from authority. People will read about their bodies. They have a right to information from the highest accredited source. And to apply such knowledge Dr. Winslow has labored for many years during his practicing experience, condensing and setting into clear order the most vitally important facts of domestic disease and treatment; an eminently qualified staff of practicing specialists has cooeperated, with criticism and supervision of incalculable value to the reader; and the accepted classics in their field follow: Dr. Weir Mitchell's elegant and inspiring essays on Nerves, Outdoor Life, etc.; Sir Henry Thompson's "precious documents of personal experience" on Diet and Conduct for Long Life; Dr. Dudley A. Sargent's scientific and long-prepared system of exercises without apparatus; Gerhard's clear principles of pure water supply; Dr. Darlington's notes and editing from the unequaled opportunity of a New York City Health Commissioner—and many other "special contributions."

It is the widely accepted modern medicine, and no school or "system," that is reflected here. While medicine, as a science, is far from being perfect, partly because of faulty traditions and misinterpreted experience, yet the aim of the modern school is to base practice on facts. For example, for many years physicians were aware that quinine cured malaria, in some unexplainable way. Now they not only know that malaria is caused by an animal parasite living and breeding in the blood and that quinine destroys the foe, but they know about the parasite's habits and mode of development and when it most readily succumbs to the drug. Thus a great discovery taught them to give quinine understandingly, at the right time, and in the right doses.

An educated physician has at his command all knowledge, past and present, pertaining to medicine. He is free to employ any means to better his patient. Now it is impossible to cure, or even better, all who suffer from certain disease by any one method, and a follower of a special "system" thus ignores many agencies which might prove efficient in his case. While there is a germ of good and truth in the various "systems" of medical practice, their representatives possess no knowledge unknown to science or to the medical profession at large. Many persons are always attracted by "something new." But newness in a medical sect is too often newness in name only. These systems rise and fall, but scientific, legitimate medicine goes ever onward with an eye single to the discovery of new facts.

That these volumes will result in an impetus to saner, quieter, steadier living, and will prove a helpful friend to many a physician and many a layman, is the earnest wish of

THE PUBLISHERS.



Part I

FIRST AID IN EMERGENCIES

BY

KENELM WINSLOW

AND

ALBERT WARREN FERRIS



Introductory Note

With the exception of the opening chapter, which contains the valuable Life-saving Service Rules verbatim, the Editors have adopted the plan of beginning each article in Part I of this volume with a few simple, practical instructions, telling the reader exactly what to do in case of an accident. For the purpose of distinguishing them from the ordinary text, and making them easy of reference, these "First-aid Rules" are printed in light-faced type.



CHAPTER I

Restoring the Apparently Drowned

As Practiced in the United States Life-Saving Service

NOTE.—These directions differ from those given in the last revision of the Regulations by the addition of means for securing deeper inspiration. The method heretofore published, known as the Howard, or direct method, has been productive of excellent results in the practice of the service, and is retained here. It is, however, here arranged for practice in combination with the Sylvester method, the latter producing deeper inspiration than any other known method, while the former effects the most complete expiration. The combination, therefore, tends to produce the most rapid oxygenation of the blood—the real object to be gained. The combination is prepared primarily for the use of life-saving crews where assistants are at hand. A modification of Rule III, however, is published as a guide in cases where no assistants are at hand and one person is compelled to act alone. In preparing these directions the able and exhaustive report of Messrs. J. Collins Warren, M.D., and George B. Shattuck, M.D., committee of the Humane Society of Massachusetts, embraced in the annual report of the society for 1895-96, has been availed of, placing the department under many obligations to these gentlemen for their valuable suggestions.

IF SEVERAL ASSISTANTS ARE AT HAND.

RULE I. Arouse the Patient.—Do not move the patient unless in danger of freezing; instantly expose the face to the air, toward the wind if there be any; wipe dry the mouth and nostrils; rip the clothing so as to expose the chest and waist; give two or three quick, smarting slaps on the chest with the open hand.

If the patient does not revive, proceed immediately as follows:

RULE II. To Expel Water from the Stomach and Chest (see Fig. 1).—Separate the jaws and keep them apart by placing between the teeth a cork or small bit of wood, turn the patient on his face, a large bundle of tightly rolled clothing being placed beneath the stomach; press heavily on the back over it for half a minute, or as long as fluids flow freely from the mouth.



RULE III. To Produce Breathing (see Figs. 2 and 3).—Clear the mouth and throat of mucus by introducing into the throat the corner of a handkerchief wrapped closely around the forefinger; turn the patient on the back, the roll of clothing being so placed as to raise the pit of the stomach above the level of the rest of the body. Let an assistant, with a handkerchief or piece of dry cloth, draw the tip of the tongue out of one corner of the mouth (which prevents the tongue from falling back and choking the entrance to the windpipe), and keep it projecting a little beyond the lips. Let another assistant grasp the arms, just below the elbows, and draw them steadily upward by the sides of the patient's head to the ground, the hands nearly meeting (which enlarges the capacity of the chest and induces inspiration). (Fig. 2.) While this is being done let a third assistant take position astride the patient's hips with his elbows resting upon his own knees, his hands extended ready for action. Next, let the assistant standing at the head turn down the patient's arms to the sides of the body, the assistant holding the tongue changing hands if necessary[1] to let the arms pass. Just before the patient's hands reach the ground the man astride the body will grasp the body with his hands, the balls of the thumb resting on either side of the pit of the stomach, the fingers falling into the grooves between the short ribs. Now, using his knees as a pivot, he will, at the moment the patient's hands touch the ground, throw (not too suddenly) all his weight forward on his hands, and at the same time squeeze the waist between them, as if he wished to force something in the chest upward out of the mouth; he will deepen the pressure while he slowly counts one, two, three, four (about five seconds), then suddenly let go with a final push, which will spring him back to his first position.[2] This completes expiration. (Fig. 3.)



At the instant of his letting go, the man at the patient's head will again draw the arms steadily upward to the sides of the patient's head as before (the assistant holding the tongue again changing hands to let the arms pass if necessary), holding them there while he slowly counts one, two, three, four (about five seconds).

Repeat these movements deliberately and perseveringly twelve to fifteen times in every minute—thus imitating the natural motions of breathing.

If natural breathing be not restored after a trial of the bellows movement for the space of about four minutes, then turn the patient a second time on the stomach, as directed in Rule II, rolling the body in the opposite direction from that in which it was first turned, for the purpose of freeing the air passage from any remaining water. Continue the artificial respiration from one to four hours, or until the patient breathes, according to Rule III; and for a while, after the appearance of returning life, carefully aid the first short gasps until deepened into full breaths. Continue the drying and rubbing, which should have been unceasingly practiced from the beginning by assistants, taking care not to interfere with the means employed to produce breathing. Thus the limbs of the patient should be rubbed, always in an upward direction toward the body, with firm-grasping pressure and energy, using the bare hands, dry flannels, or handkerchiefs, and continuing the friction under the blankets, or over the dry clothing. The warmth of the body can also be promoted by the application of hot flannels to the stomach and armpits, bottles or bladders of hot water, heated bricks, etc., to the limbs and soles of the feet.

RULE IV. After Treatment. Externally.—As soon as breathing is established let the patient be stripped of all wet clothing, wrapped in blankets only, put to bed comfortably warm, but with a free circulation of fresh air, and left to perfect rest. Internally: Give whisky or brandy and hot water in doses of a teaspoonful to a tablespoonful, according to the weight of the patient, or other stimulant at hand, every ten or fifteen minutes for the first hour, and as often thereafter as may seem expedient. Later Manifestations: After reaction is fully established there is great danger of congestion of the lungs, and if perfect rest is not maintained for at least forty-eight hours, it sometimes occurs that the patient is seized with great difficulty of breathing, and death is liable to follow unless immediate relief is afforded. In such cases apply a large mustard plaster over the breast. If the patient gasps for breath before the mustard takes effect, assist the breathing by carefully repeating the artificial respiration.

IF ONE PERSON MUST WORK ALONE.

MODIFICATION OF RULE III

[To be used after Rules I and II in case no assistance is at hand]

To Produce Respiration.—If no assistance is at hand, and one person must work alone, place the patient on his back with the shoulders slightly raised on a folded article of clothing; draw forward the tongue and keep it projecting just beyond the lips; if the lower jaw be lifted, the teeth may be made to hold the tongue in place; it may be necessary to retain the tongue by passing a handkerchief under the chin and tying it over the head.[3]

Grasp the arms just below the elbows and draw them steadily upward by the sides of the patient's head to the ground, the hands nearly meeting. (See Fig. 4.)

Next lower the arms to the side, and press firmly downward and inward on the sides and front of the chest over the lower ribs, drawing arms toward the patient's head. (See Fig. 5.)

Repeat these movements twelve to fifteen times every minute, etc.



INSTRUCTIONS FOR SAVING DROWNING PERSONS BY SWIMMING TO THEIR RELIEF.

1. When you approach a person drowning in the water, assure him, with a loud and firm voice, that he is safe.

2. Before jumping in to save him, divest yourself as far and as quickly as possible of all clothes; tear them off, if necessary; but if there is not time, loose at all events the foot of your drawers, if they are tied, as, if you do not do so, they fill with water and drag you.

3. On swimming to a person in the sea, if he be struggling do not seize him then, but keep off for a few seconds till he gets quiet, for it is sheer madness to take hold of a man when he is struggling in the water, and if you do you run a great risk.

4. Then get close to him and take fast hold of the hair of his head, turn him as quickly as possible on to his back, give him a sudden pull, and this will cause him to float, then throw yourself on your back also and swim for the shore, both hands having hold of his hair, you on your back, and he also on his, and of course his back to your stomach. In this way you will get sooner and safer ashore than by any other means, and you can easily thus swim with two or three persons; the writer has even, as an experiment, done it with four, and gone with them forty or fifty yards in the sea. One great advantage of this method is that it enables you to keep your head up, and also to hold the person's head up you are trying to save. It is of primary importance that you take fast hold of the hair, and throw both the person and yourself on your backs. After many experiments, it is usually found preferable to all other methods. You can in this manner float nearly as long as you please, or until a boat or other help can be obtained.

5. It is believed there is no such thing as a death grasp; at least, it is very unusual to witness it. As soon as a drowning man begins to get feeble and to lose his recollection, he gradually slackens his hold until he quits it altogether. No apprehension need, therefore, be felt on that head when attempting to rescue a drowning person.

6. After a person has sunk to the bottom, if the water be smooth, the exact position where the body lies may be known by the air bubbles, which will occasionally rise to the surface, allowance being, of course, made for the motion of the water, if in a tide way or stream, which will have carried the bubbles out of a perpendicular course in rising to the surface. Oftentimes a body may be regained from the bottom, before too late for recovery, by diving for it in the direction indicated by these bubbles.

7. On rescuing a person by diving to the bottom, the hair of the head should be seized by one hand only, and the other used in conjunction with the feet in raising yourself and the drowning person to the surface.

8. If in the sea, it may sometimes be a great error to try to get to land. If there be a strong "outsetting tide" and you are swimming either by yourself or having hold of a person who cannot swim, then get on your back and float till help comes. Many a man exhausts himself by stemming the billows for the shore on a back-going tide, and sinks in the effort, when, if he had floated, a boat or other aid might have been obtained.

9. These instructions apply alike to all circumstances, whether as regards the roughest sea or smooth water.

FOOTNOTES:

[1] Changing hands will be found unnecessary after some practice; the tongue, however, must not be released.

[2] A child or very delicate patient must, of course, be more gently handled.

[3] If there is stuck through the tongue a pin long enough to rest against the teeth and keep the tongue out of the mouth, the desired effect may be obtained.—EDITOR.



CHAPTER II

Heat Stroke and Electric Shock

How Persons are Overcome by Heat—Treatment of Sunstroke—Peculiar Cases—Dangers of Electric Shocks—How Death is Caused—Rules and Precautions.

HEAT EXHAUSTION.

First Aid Rule 1.—Carry patient flat and lay in shade. Loosen clothes at neck and waist.

Rule 2.—Raise head and give him (a) teaspoonful of essence of ginger in glass of hot water, or give him (b) half a cup of hot coffee, clear.

Rule 3.—Put him to bed.

HEAT STROKE.

First Aid Rule 1.—Send for physician.

Rule 2.—Remove quickly to shady place, loosening clothes on the way.

Rule 3.—Strip naked and put on wire mattress (or canvas cot), if obtainable.

Rule 4.—Sprinkle with ice water from watering pot, or dash it out of basin with hand.

Rule 5.—Dip sheet in ice water and tuck it snugly about patient.

Rule 6.—Sprinkle outside of sheet with ice water; rub body, through the sheet, with piece of ice. Put piece of ice to nape of neck.

Rule 7.—When temperature falls to 98.5 deg. F. put to bed with ice cap on head.

SUNSTROKE.—There are two very distinct types of sunstroke: (1) Heat exhaustion or heat prostration. (2) Heat stroke.

Heat prostration or exhaustion occurs when persons weakened by overwork, worry, or poor food are exposed to severe heat combined with great physical exertion. It often attacks soldiers on the march, but also those not exposed to the direct rays of the sun, as workers in laundries, in boiler rooms, and in stoke-holes of steamers. The attack begins more often in the afternoon or evening, in the case of those exposed to out-of-door heat. Feelings of weakness, dizziness, and restlessness, accompanied by headache, are among the first symptoms. The face is very pale, the skin is cool and moist, although the trouble often starts with sudden arrest of sweating. There is great prostration, with feeble, rapid pulse, frequent and shallow breathing, and lowered temperature, ranging often from 95 deg. to 96 deg. F. The patient usually retains consciousness, but rarely there is complete insensibility. The pernicious practice of permitting children at seaside resorts to wade about in cold water while their heads are bared to the burning sun is peculiarly adapted to favor heat prostration.

Heat stroke happens more frequently to persons working hard under the direct rays of the sun, especially laborers in large cities who are in the habit of drinking some form of alcohol. It often occurs in unventilated tenements on stifling nights. Dizziness, violent headache, seeing spots before the eyes, nausea, and attempts at vomiting, usher in the attack. Compare it with heat prostration, and note the marked differences. The patient becomes suddenly and completely insensible, and falls to the ground, the face is flushed, the breathing is noisy and difficult, the pulse is strong, and the thermometer placed in the bowel registers 107 deg., 108 deg., or 110 deg. F., or rarely higher. The muscles are usually relaxed, but sometimes there are twitchings, or even convulsions. Death often occurs within twenty-four or thirty-six hours, preceded by failing pulse, deep unconsciousness, and rapid breathing, often labored or gasping, alternating with long intermissions. Sometimes delirium and unconsciousness last for days. Diminution of fever and returning consciousness herald recovery, but it is a very fatal disorder, statistics showing a death rate of from thirty to fifty per cent. Even when the patient lives, bad after effects are common. Peculiar sensibility to moderate heat is a frequent complaint. Loss of memory, weakened mental capacity, headache, irritability, fits, other mental disturbances, and impairment of sight and hearing are among the more usual sequels, occurring in those who do not subsequently avoid the direct rays of the sun, as well as an elevated temperature, and who indulge in alcoholic stimulants. A high degree of moisture in the air favors sunstrokes, but it is a curious fact that sunstroke is much more frequent in certain localities, and in special years than at other places and times with identical climatic conditions. This has led observers to suggest a germ origin of the disease, but this is extremely doubtful.

Treatment.—Treatment for heat exhaustion is given in the "first-aid" directions. Little need be added to the directions for treatment of heat stroke. In place of the ice cap suggested in Rule 7, ice in cloths, or in a sponge bag may be substituted. The friction of the body, as directed in Rule 6, is absolutely necessary to stimulate the nervous system and circulation, and to prevent the blood from being driven into the internal organs by the cold applied externally. The cold-water treatment is applied until the temperature falls down to within a few degrees of normal—that is, 98.6 deg. F. Then the patient should be put into bed, there to remain, with ice to the head, until fully restored.

It often happens that the fever returns, in which event the whole process of applying cold water must be repeated. The simplest way of reducing the fever consists in laying the patient, entirely nude, on a canvas cot or wire mattress, binding ice to the back of his neck, and having an attendant stand on a chair near by and pour ice water upon the patient from a garden watering pot.

While the patient is insensible no attempt should be made to give anything by the mouth; but half a pint of milk and two raw eggs with a pinch of salt may be injected into the rectum every eight hours, after washing it out with cold water on each occasion. Two tablespoonfuls of whisky may be added to the injection, if the pulse is weak. If the urine is not passed spontaneously, it will be necessary to draw it once in eight hours with a soft rubber catheter which has been boiled ten minutes and lubricated with glycerin or clean vaseline.

ELECTRIC SHOCK OR LIGHTNING STROKE.

First Aid Rule 1.—Protect yourself from being shocked by the victim. Grasp victim only by coat tails or dry clothes. Put rubber boots on your hands, or work through silk petticoat; or throw loop of rubber suspenders or of dry rope around him to pull him off wire, or pry him along with dry stick.

Rule 2.—Do not lift, but drag victim away from wire toward the ground. When free from wire, hold him head downward for two minutes.

Rule 3.—Assist heart to regain its strength. Apply mustard plaster (mustard and water) to chest over heart; wrap in blanket wrung out of very hot water; give hypodermic of whisky, thirty minims.

Rule 4.—Induce artificial respiration. Open his mouth and grasp tongue, pull it forward just beyond lips, and hold it there. Let another assistant grasp the arms just below the elbows and draw them steadily upward by the sides of the patient's head to the ground, the hands nearly meeting (which enlarges the capacity of the chest and induces inspiration, Fig. 2). While this is being done, let a third assistant take position astride the patient's hips with his elbows resting on his own knees, his hands extended, ready for action. Next, let the assistant standing at the head turn down the patient's arms to the sides of the body, the assistant holding the tongue changing hands, if necessary, to let the arms pass. Just before the patient's hands reach the ground, the man astride the body will grasp the body with his hands, the ball of the thumb resting on either side of the pit of the stomach, the fingers falling into the grooves between the short ribs. Now, using his knees as a pivot, he will at the moment the patient's hands touch the ground throw (not too suddenly) all his weight forward on his hands, and at the same time squeeze the waist between them, as if he wished to force something in the chest upward out of the mouth; he will deepen the pressure while he slowly counts one, two, three, four (about five seconds), then suddenly lets go with a final push, which will send him back to his first position. This completes expiration. (A child or delicate person must be more gently handled.)

At the instant of letting go, the man at the patient's head will again draw the arms steadily upward to the sides of the patient's head, as before (the assistant holding the tongue again changing hands to let the arms pass, if necessary), holding them there while he slowly counts one, two, three, four (about five seconds).

Repeat these movements deliberately and perseveringly twelve to fifteen times in every minute—thus imitating the natural motions of breathing. Continue the artificial respiration from one to four hours, or until the patient breathes; and for a while, after the appearance of returning life, carefully aid the first short gasps until deepened into full breaths.

Keep body warm with hot-water bottles, hot bricks to limbs and feet, and blankets over exposed lower part of body.

Rule 5.—Treat burn, if any. If skin is not broken, cover burn with cloths wet with Carron oil (equal parts of limewater and linseed or olive oil). If skin is broken, or raw surface is exposed, spread over it paste of equal parts of boric acid and vaseline, and bandage over all.

Conditions, Etc.—A shock produced by contact with an electric current is not of rare occurrence. Lightning stroke is very uncommon; statistics show that in the United States each year there is one death from this cause to each million of inhabitants. There are several conditions which must be borne in mind when considering the accidental effect of an electric current. The pressure and strength of the current (voltage and amperage) are often not nearly so important in regard to the effects on the body, as the area, duration, and location of the points of contact with the current, and the resistance offered by clothing and dry skin to the penetration of the electricity.

When the heart lies in the course of the circuit, the danger is greatest. A dog can be killed by a current of ten volts pressure when contacts are made to the head and hind legs, because the current then flows through the heart, while a current of eighty volts is required to kill a dog, under the same conditions, if contacts are made to head and fore leg. In a general way alternating currents of low frequency are the most injurious to the body, and any current pressure higher than two hundred volts is dangerous to life. On the other hand, a current of ninety-five volts has proved fatal to a human being. In this case the circumstances were particularly unfavorable to the victim, as he was standing on an iron tank in boots wet with an alkaline solution, and probably studded on the soles with nails, when he came in accidental contact with an industrial current. Moreover, he was an habitual drunkard. In an instance of the contrary sort, a man received a current of 1,700 volts (periodicity about 130) for fifty seconds, in one of the early attempts at electro-execution, without being killed. The personal equation evidently enters into the matter. A strong physique here, as in other cases, is most favorable in resisting the effects of electric shock.

High-pressure alternating currents (1,300 to 2,000 volts) are employed in electro-executions, and the contacts are carefully made, so that the current will enter the brain and pass through the heart to the leg. The two most vital parts are thus affected. In industrial accidents such nice adjustments are fortunately almost impossible, and shocks received from high-pressure currents, even of 25,000 volts, have not proved fatal because both the voltage and amperage have been greatly lessened through poor contacts and great resistance of clothing and dry skin, and also because the heart is not usually included in the circuit.

Death is induced in one of three ways: 1. Currents of enormous voltage and amperage, as occur in lightning, actually destroy, burst and burn the tissues through which the stroke passes. 2. Usually death follows accidents from industrial currents, owing to contraction of the heart, the effect being the same as observed on other muscles. The heart instantly ceases beating, and either remains absolutely quiet, or there is a fine quivering of some of its fibers, as seen on opening the chest in experiments upon animals. 3. A fatal issue may result from the passage of the current through the head, so affecting the nerve centers that govern respiration that the breathing ceases.

Symptoms.—These are generally muscular contractions, faintness, and unconsciousness (sometimes convulsions, if the current passes through the head), with failure of pulse and of breathing. For instance, a man who was removing a brush from a trolley car touched, with the other hand, a live rail. His muscles immediately contracted throwing him back, and disconnecting him from contact with the current (500 volts). He then fainted and became unconscious for a short time. The pulse was rapid and feeble, and the breathing also at first, but it later became slower than usual. On regaining sensibility the patient vomited and got on his feet, although feeling very weak for two hours. Unconsciousness commonly lasts only a few moments in nonfatal cases, but may continue for hours, its continuance being rather a favorable sign of ultimate recovery, if the heart and lungs are acting sufficiently. Bad after effects are rare. It is not uncommon for the patient to declare that the accident had improved his general feelings. Occasionally there is temporary loss of muscular power, and a case has been reported of nervous symptoms following electric shock similar to those observed after any accidental violence. Burns of varying degrees of intensity occur at the point of entrance of the current, from slight blisters to complete destruction of all the tissues.

Treatment.—The treatment is completely outlined in the "first-aid" directions. Should contact be unbroken, an order to shut off the electric current should at once be telephoned to the station. Protection of the rescuer with thick rubber gloves is of course the ideal safeguard.

In fatal cases the heart is instantaneously arrested, and nothing can be done to start it into action. If the current passes through the brain, by contact with the head or neck, then failure of breathing is more apt to be the cause of death. Theoretically, it is in the latter event only that treatment, i. e., artificial respiration, will be of avail.

But as in any individual case the exact condition is always a matter of doubt, artificial respiration is the most valuable remedial measure we possess; it should always be practiced for hours in doubtful cases. Two tablespoonfuls of brandy or whisky in a cup of warm water may be injected into the bowel, if a hypodermic syringe is not available and the patient needs decided stimulation.



CHAPTER III

Wounds, Sprains and Bruises

Treatment of Wounds—Rules for Checking Hemorrhage—Lockjaw—Bandages for Sprains—Synovitis—Bunions and Felons—Foreign Bodies in the Eye, Ear and Nose.

WOUNDS.—A wound is a condition produced by a forcible cutting, contusing, or tearing of the tissues of the body, and includes, in its larger sense, bruises, sprains, dislocations, and breaks or fractures of bones. As ordinarily used, a wound is an injury produced by forcible separation of the skin or mucous membrane, with more or less injury to the underlying parts.

The main object during the care of wounds should be to avoid contamination with anything which is not surgically clean, from the beginning to the end of the dressing; otherwise, every other step in the whole process is rendered useless.

Three essentials in the treatment of wounds are:

1. The arrest of bleeding. 2. Absolute cleanliness. 3. Rest of the injured part. Dangerous bleeding demands immediate relief.

Bleeding is of three kinds: 1. From a large artery. 2. From a vein. 3. General oozing.

BLEEDING FROM LARGE ARTERY IN SPURTS OF BRIGHT BLOOD.

First Aid Rule 1.—Speed increases safety. Put patient down flat. Make pressure with hands between the wound and the heart till surgeon arrives, assistants taking turns.

Rule 2.—If arm or leg, tie rubber tubing or rubber suspenders tight about limb between wound and heart, or tie strap or rope over handkerchief or folded shirt wrapped about limb. If arm, put baseball in arm pit, and press arm against this. Or, for arm or leg, tie folded cloth in loose noose around limb, put cane or umbrella through noose and twist up the slack very tight, so as to compress the main artery with knot.

Rule 3.—Keep limb and patient warm with hot-water bottles till surgeon arrives.

This treatment is of course only a temporary expedient, as it is essential for a surgeon to tie the bleeding vessel itself; therefore a medical man should be summoned with all dispatch.

BLEEDING FROM VEIN; STEADY FLOW OF DARK BLOOD.

First Aid Rule 1.—Make firm pressure with pad of cloth directly over wound, also with hands between wound and extremity, that is, on side of cut away from the heart.

Rule 2.—Tie tight bandage about limb at this point, with rubber tubing or suspenders.

Rule 3.—Keep limb and patient warm with hot-water bottles till surgeon arrives.

In the cases of bleeding from a vein, the flow of blood is continuous, and is of a dark, red hue, and does not spurt in jets, as from an artery. This kind of bleeding is not usually difficult to stop, and it is not necessary that the vein itself be tied—unless very large—provided that the wound be snugly bandaged after it is dressed. After the first half hour, release the limb and see if the bleeding has stopped. If so, and the circulation is being interfered with, owing to the tightness of the bandage, reapply the bandage more loosely.

In the case of an injured artery of any considerable size, the amount of pressure required to stop the bleeding will arrest all circulation of blood in the limb, so that great damage, as well as pain, will ensue if it be continued more than an hour or two, and during this time the limb should be kept warm by thick covering and hot-water bags, if they can be obtained.

Bleeding from a deep puncture may be stopped by plugging the cavity with strips of muslin which have been boiled, or with absorbent cotton, similarly treated, keeping the plug in place by snug bandaging.

BLEEDING FROM PUNCTURED WOUND.

First Aid Rule 1.—Extract pin, tack, nail, splinter, thorn, or bullet, IF YOU CAN SEE BULLET; do not probe.

Rule 2.—Pour warm water on wound and squeeze tissue to encourage bleeding. Send for small hard-rubber syringe.

Rule 3.—If deep, plug it with absorbent cotton, and put tight bandage over plug. If shallow, cover with absorbent cotton wet with boric-acid solution (one dram to one-half pint of water), or carbolic-acid solution (one teaspoonful to the pint of hot water).

Rule 4.—When syringe comes, remove dressing, and clean wound by forcibly syringing carbolic solution directly into wound. Replace dressing.

A small punctured wound should be squeezed in warm water to encourage bleeding and, if pain and swelling ensue, absorbent cotton soaked in a boric-acid solution (containing as much boric acid as the water will dissolve) or in carbolic-acid solution (one teaspoonful of pure acid to the pint of warm water) should be applied over the wound and covered with oil silk or rubber or enamel cloth for a few days, or until the soreness has subsided. The dressing should be wet with the solution as often as it becomes dry. Punctures by nails, especially if deep, should be washed out with a syringe, using one of the solutions just mentioned. A medicine dropper, minus the rubber part, attached to a fountain syringe, makes a good nozzle for this purpose. A moist dressing, like the one described, should then be applied, and the limb kept in perfect rest for a few days.

When a surgeon's services are available, however, self-treatment is attended with too much danger, as a thorough opening up of such wounds with proper cleansing and drainage will afford a better prospect of early recovery, and avert the risk of serious inflammation and lockjaw, which sometimes follow punctured wounds of the hands and feet. Foreign bodies, as splinters, may be removed with tweezers or a needle, being careful not to break the splinter in the attempt. If a part remains in the flesh, or if the foreign body is a needle that cannot be found or removed at once, the continuous application of a hot flaxseed or other poultice will lead to the formation of "matter," with which the splinter or needle will often escape after a few days. Splinters finding their way under the nail may be removed by scraping the nail very thin over the splinter and splitting it with a sharp knife down to the point where the end of the splinter can be grasped.

BLEEDING IN FORM OF OOZING.

First Aid Rule 1.—Apply water as hot as hand can bear.

Rule 2.—Elevate the part, and drench with carbolic solution (one teaspoonful of carbolic acid to one pint of hot water).

Rule 3.—Bandage snugly while wet.

Rule 4.—Keep patient warm with hot-water bottles.

GENERAL OOZING happens in the case of small wounds or from abraded surfaces, and is caused by the breaking of numerous minute vessels which are not large enough to require the treatment recommended for large arteries or veins. It is rarely dangerous, and usually stops spontaneously. When the loss of blood has been considerable, so that the patient is pale, faint, and generally relaxed, with cold skin, and perhaps nausea and vomiting, he should be stripped of all clothing and immediately wrapped in a blanket wrung out of hot water, and then covered with dry blankets. Heat should also be applied to the feet by means of hot-water bags or bottles, with great care not to burn a semiconscious patient's skin. The head should be kept low, and two tablespoonfuls of brandy, whisky, or other alcoholic liquor should be given in a half cup of hot water by the mouth, if the patient can swallow. If much blood has been lost a quart of water, as hot as the hand can readily bear, and containing a teaspoonful of common salt, should be injected by means of a fountain syringe into the rectum.

Somewhat the condition just described as due to loss of blood may be caused simply by shock to the nervous system following any severe accident, and not attended by bleeding. The treatment of shock is, however, practically the same as that for hemorrhage, and improvement in either case is shown by return of color to the face and strength in the pulse. Bleeding is apt to be much less in badly torn than in incised wounds, even if large vessels are severed, as when the legs are cut off in railroad accidents, for the lacerated ends of the vessels become entangled with blood and favor clotting.

LOCKJAW.—In the lesser injuries, where bleeding is not an important feature, and in all wounds as well, after bleeding has been stopped, the main object in treatment consists in cleansing wounds of the germs which cause "matter" or pus, general blood poisoning, and lockjaw. The germs of the latter live in the earth, and even the smallest wounds which heal perfectly may later give rise to lockjaw if dirt has not been entirely removed from the wound at the time of accident. Injuries to the hands caused by pistols, firecrackers, and kindred explosives, seem especially prone to produce lockjaw, and fatalities from this disorder are deplorably numerous after Fourth-of-July celebrations in the United States.

The wounds producing lockjaw usually occur in children who explode blank cartridges in the palm of the hand. In this way the germs of the disease are forced in with parts of the dirty skin and more or less of the wad from the shell. Since lockjaw is so frequent after these accidents, and so fatal, it is impossible to exert too much care in treatment. The wound should at once be thoroughly opened with a knife to the very bottom, under ether, by a surgeon, and not only every particle of foreign matter removed, but all the surrounding tissue should be cut out or cauterized. In addition, it is wise to use an injection under the skin of tetanus-antitoxin, to prevent the disease. Proper restriction of the sale of explosives alone will put a stop to this barbarous mode of exhibiting patriotism.

Treatment.—It is not essential to use chemical agents or antiseptics to rid wounds of germs and so secure uninterrupted healing. The person who is to dress the wound should prepare to do so at the earliest possible moment after giving first aid. He should proceed promptly to boil some pieces of absorbent cotton, as large as an egg, together with a nail brush in water. Some strips of clean cotton cloth may be used in the absence of absorbent cotton. The boiling should be conducted for five minutes, when the basin or other utensil in which the brush and cotton are boiled should be taken off the fire and set aside to cool. Then the attendant should scrub his own hands for five minutes in hot water with soap and brush.

He next takes the brush, which has been boiled, out of the water and cleans the patient's skin for a considerable distance about the wound. When this is done, and the water and cotton which have been boiled are sufficiently cool, the wound should be bathed with the cotton and boiled water until all foreign matter has been removed from the wound; not only dirt which can be seen, but germs which cannot be seen. Some of the boiled cotton cloth or absorbent cotton, wet as it is, should be placed over the wound and the whole covered by a bandage. Large gaping wounds are of course more properly closed by stitches, but very deep wounds should be left partly open, so that the discharge may drain away freely. Small, deep, punctured wounds are not to be closed at all, but should be sedulously kept open by pushing in strips of boiled cotton cloth, in order to secure drainage.

If the attendant has the requisite confidence, there is no reason why he should not attempt stitching a wound, providing the patient is willing, and a surgeon cannot be obtained within twenty-four hours. In this case a rather stout, common sewing needle or needles are threaded with black or white thread, preferably of silk, and, together with a pair of scissors and a clean towel, are boiled in the same utensil with the cotton and the nail brush. After the operator has scrubbed his hands and cleansed the wound, he places the boiled towel about the wound so that the thread will fall on it during his manipulations and not on the skin. The needle should be thrust into and through the skin, but no lower than this, and should enter and leave the skin about a quarter of an inch from either edge of the wound. The stitches are placed about one-half inch apart, and are drawn together and tied tightly enough to join the two edges of the wound. The ends of the thread should be cut about one-half inch from the knot, being careful while using the needle and scissors not to lay them down on anything except the boiled towel. The wound is then covered with cotton, which has been boiled as described above, bandaged and left undisturbed for a week, if causing no pain. At the end of this time the stitches are taken out after the attendant has washed his hands carefully, and boiled his scissors as before.

Court plaster or plaster of any kind is a bad covering or dressing for wounds, as it may be itself contaminated with germs. It effectually keeps in any with which the wound is already infected, and prevents proper drainage.

It is impossible in a work of this kind to describe the details of the after treatment of wounds, as this can only be properly undertaken by a surgeon, owing to the varying conditions which may arise. In general it may be stated that the same cleanliness and care should be followed during the whole course of healing as has been outlined for the first attempt at treatment.

If the wound is small, and there is no discharge from it, it may be painted with collodion or covered with boric-acid ointment (sixty grains of boric acid to the ounce of vaseline) after the first day. If large, it should be covered with cotton gauze or cloth which have been boiled or specially prepared for surgical purposes. If pus ("matter") forms, the wound must be cleansed daily of discharge (more than once if it is copious) with boiled water, or best with hydrogen dioxide solution followed by a washing with a solution of carbolic acid (one teaspoonful to the pint of hot water), or with a solution of mercury bichloride, dissolving one of the larger bichloride tablets, sold for surgical uses, in a quart of water.

It is a surgical maxim never to be neglected that wounds should not be allowed to close at the top before healing is completed at the bottom. As to close at the surface is the usual tendency in wounds that heal slowly and discharge pus, it is necessary at times to enlarge the external opening by cutting or stretching with the blades of a pair of scissors, or, and this is much more rational and comfortable for the patient, by daily packing the outlet of the wound with gauze to keep it open.

BLEEDING FROM SCALP.

First Aid Rule 1.—Cut hair off about wound, and clean thoroughly with carbolic-acid solution (one teaspoonful to pint of hot water).

Rule 2.—Put pad of gauze or muslin directly over wet wound, and make pressure firmly with bandage.

In case of wounds of the scalp, or other hairy parts, the hair should be cut, or better shaved, over an area very much larger than the wounded surface, after which the cleansing should be done. To stop bleeding of the scalp, water is applied as hot as can be borne, and then a wad of boiled cotton should be placed in the wound and bandaged down tightly into it for a time. Closing the wound with stitches will stop the bleeding much more effectively, however, and is not very painful if done immediately after the accident. The stitches should be tied loosely, and not introduced nearer to each other than half an inch, to allow drainage of discharge from the wound.

General Remarks.—All wounds should be kept at rest after they are dressed. This is accomplished in the case of the lower limbs by keeping the patient in bed with the leg raised on a pillow.

The same kind of treatment applies in severe injuries of the hands. In less serious cases a sling may be employed, and the patient may walk about. When the injury is near a joint, as of the fingers, knee, wrist, or elbow, a splint made of thin board or tin (and covered with cotton wadding and bandaged) should be applied by means of surgeon's adhesive plaster and bandage after the wound has been dressed. In injuries of the hand the splint should be applied to the palm side, and reach from the finger tips to above the wrist. Use a splint also.

NOSEBLEED.

First Aid Rule 1.—Seat patient erect and apply ice to nape of neck.

Rule 2.—Put roll of brown paper under upper lip, and press lip firmly against it. Press facial artery against lower jaw of bleeding side, till bleeding stops. This artery crosses lower edge of jawbone one inch in front of angle of jaw.

Rule 3.—Plug nostril with strip of thin cotton or muslin cloth.

Rule 4.—Do not wash away clots; encourage clotting to close nostril.

BLEEDING FROM LUNGS; BRIGHT BLOOD COUGHED UP.

BLEEDING FROM STOMACH; DARK BLOOD VOMITED.

First Aid Rule for both. Let patient lie flat and swallow small pieces of ice, and also take one-quarter teaspoonful of table salt in half a glass of cold water.

BRUISE.

First Aid Rule 1.—Bandage from tips of fingers, or from toes, making same pressure with bandage all the way up as you do over the injury.

Rule 2.—Apply heat through the bandage, over the injury, with hot-water bottles.

Cause, Etc.—A bruise is a hidden wound; the skin is not broken. It is an injury caused by a blunt body so that, while the tougher skin remains intact, the parts beneath are torn and crushed to a greater or lesser extent. The smaller blood vessels are torn and blood escapes under the skin, giving the "black and blue" appearance so common in bruises of any severity. Sometimes, indeed, large collections of blood form beneath the skin, causing a considerable swelling.

Use of the bruised part is temporarily limited. Pain, faintness, and nausea follow severe bruises, and, in case of bad bruises of the belly, death may even ensue from damage to the viscera or to the nerves. Dangerous bleeding from large blood vessels sometimes takes place internally, and collections of blood may later break down into abscesses. Furthermore, the bruise may be so great that the injury to muscle and nerve may lead to permanent loss of use of the part. For these reasons a surgeon's advice should always be sought in cases of bad bruises. Pain is present in bruises, owing to the tearing and stretching of the smaller nerve fibers, and to pressure on the nerves caused by swelling. The swelling is produced by escape of blood and fluid from the torn blood vessels.

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