The Home Medical
Library

[Pg 5]

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.

[Pg 19]

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[Pg 20] 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 ap[Pg 21]pealing 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[Pg 22] 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 mis[Pg 23]information 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 coöperated, 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 unex[Pg 24]plainable 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.

[Pg 26]

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.

[Pg 27]

Restoring the Apparently Drowned

As Practiced in the United States Life-Saving Service

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.

[Pg 28]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[Pg 29] 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)[Pg 30]
[Pg 31]
[Pg 32] 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[Pg 33] 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 diffi[Pg 34]culty 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.

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[Pg 35]
[Pg 36] 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.

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[Pg 37] 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[Pg 38] 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.

[Pg 39]

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;[Pg 40] 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° 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° to 96° 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.

[Pg 41]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°, 108°, or 110° 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[Pg 42] 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° 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.

[Pg 43]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[Pg 44] 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[Pg 45] 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[Pg 46] (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.

[Pg 47]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[Pg 48] 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,[Pg 49] 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.

[Pg 50]

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.

[Pg 51]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.

[Pg 52]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.

[Pg 53]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[Pg 54] 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).

[Pg 55]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[Pg 56] 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[Pg 57] 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[Pg 58] 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[Pg 59] 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[Pg 60] 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[Pg 61] 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.[Pg 62] 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.[Pg 63] 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.

Treatment.—Even slight and moderate bruises should be treated by rest of the injured part. A splint insures the rest of a limb (see treatment of Fractures, p. 80). One of the best modes of treatment is the snug application of a flannel bandage which secures a certain amount of rest of the part to which it is applied, and aids in preventing further swelling. Where bandaging is not feasible, as in certain parts of the body, or before bandaging in any kind of a bruise, the use of a cold compress is advisable. One layer of thin cotton or linen cloth should be wet in ice water, and should be put on the bruised part and continually[Pg 64] changed for newly moistened pieces as soon as the first grows warm. Alcohol and water, of each equal parts, may be used in the same manner to advantage.

When cold is unavailable or unpleasant to the patient, several layers of cotton cloth may be wrung out in very hot water and applied to the part with frequent renewal. The value attributed to witch-hazel and arnica is mainly due to the alcohol contained in their preparations. Cataplasma Kaolini (U. S. P.) is an excellent remedy for simple bruises when spread thickly on the part and covered with a bandage. An ointment containing twenty-five per cent of ichthyol is also a useful application. Following severe bruises, the damaged parts should be kept warm by the use of hot-water bags, or by covering a limb with cotton wool and bandage, until such time as surgical advice may be obtained.

When the pain and swelling of bruises begin to subside, treatment should be pursued by rubbing with liniment of ammonia or chloroform, or vaseline if these are not obtainable. Moderate exercise of the part is desirable.

ABRASIONS.—When the surface skin is scraped off, as often happens to the shin, knee, or head, an ointment containing sixty grains of boric acid to the ounce of vaseline makes a good application, and this may be covered with a bandage. The same ointment is useful to apply to small wounds and cuts after the first bandage is removed.

[Pg 65]SPRAIN; NO DISPLACEMENT OF BONES.

First Aid Rule 1.—Immerse in water, hot as hand can bear, for half an hour.

Rule 2.—Dry and strap with adhesive plaster, if you know how. If not, bandage snugly, beginning with tips of fingers or with toes, and make same pressure all the way up that you do over injury.

Rule 3.—Rest. If ankle or knee is hurt, patient must go to bed.

Conditions, Etc.—A sprain is an injury caused by a sudden wrench or twist of a joint, producing a momentary displacement of the ends of the bones to such a degree that they are forced against the membrane and ligaments surrounding the joint, tearing one or both to a greater or less extent. The wrist and ankle are the joints more commonly sprained, and this injury is more likely to occur in persons with flabby muscles and relaxed ligaments, as in the so-called "weak-ankled." The damage to the parts holding the joint in place may be of any degree, from the tearing of a few fibers of the membrane enwrapping the joint to its complete rupture, together with that of the ligaments, so that the bones are no longer in place, the joint loses its natural shape and appearance, and we have a condition known as dislocation. In a sprain then, the twist of the joint produces only a temporary displacement of the bones forming the joint, sufficient to damage the soft structures around it, but not suffi[Pg 66]cient to cause lasting displacement of the bones or dislocation.

It will be seen that whether a sprain or dislocation results, depends upon the amount of injury sustained. Since it often happens that the bone entering into the joint is broken, it follows that whenever what appears to be a severe sprain occurs, with inability to move the joint and great swelling, it is important to secure surgical aid promptly. Since the discovery of the X-ray many injuries of the smaller bones of the wrist and ankle joint, formerly diagnosed as sprains by the most skillful surgeons, have, by its use, been discovered to be breaks of the bones which were impossible of detection by the older methods of examination.

Symptoms.—The symptoms of sprain are sudden, severe pain, often accompanied by faintness and nausea, swelling, tenderness, and heat of the injured parts. The sprained joint can be only moved with pain and difficulty. The swelling is due not so much to leaking of blood from broken blood vessels as to filling up of the joint with fluid caused by the inflammation, although in a few days after a severe sprain the skin a little distance below the injury becomes "black and blue" from escape of blood caused by the injury.

Treatment.—Since the treatment of severe sprains means first the discrimination between dislocation, a break of bone, and a rupture of muscle, ligament, or tendon, it follows that the methods herein described for treatment should only be employed in slight unmis[Pg 67]takable sprains, or until a surgeon can be secured, or when one is unavailable. Nothing is better than immediate immersion of the sprained joint in as hot water as the hand can bear for half an hour. Following this, an elastic bandage of flannel cut on the bias about three and one-half inches wide should be snugly applied to the limb, beginning at the finger tips or at the toes and carrying the bandage some distance above the injured joint.

In bandaging a part there is always danger of applying the bandage too tightly, especially if the parts swell under the bandage. If this happens, there is increase of pain which may be followed by numbness of the limb and, what is still more significant, coldness and blueness of the extremities below the bandage, particularly of the fingers and toes. In such cases the bandage must be removed and reapplied with less force. If the ankle or knee be sprained the patient must go to bed for at least twenty-four hours, and give the limb a complete rest.

When the wrist or shoulder is sprained the arm should be confined in a sling. In the more serious cases the injured joint should be fixed in a splint before bandaging. An injured elbow joint is held at a right angle by a pasteboard splint, a bandage, and a sling, while the knee and wrist are treated with the limb in a straight line, as far as possible.

In the case of the knee, the splint is applied to the back of the leg; in sprained wrist, to the palm of the[Pg 68] hand and same side of the forearm. Sheet wadding, which may be bought at any drygoods store, is torn into strips about two inches wide and sewed together forming a bandage ten or fifteen feet long, and this is first wound about the sprained joint. Then pieces of millboard or heavy pasteboard are soaked in water and applied while wet in long strips about three inches wide over the wadding, and the whole is covered with bandage. In the case of the knee it is better to use a strip of wood for the splint, reaching from the lower part of the calf to four inches above the knee. It should be from a quarter to half an inch thick, a little narrower than the leg, and be padded thickly with sheet wadding. It is held in place by strips of surgeon's adhesive plaster, about two inches wide, passed around the whole circumference of the limb above and below the knee joint, and covered with bandage.

In ordinary sprains of the ankle, uncomplicated by broken bone or ligament, it is possible for the patient, after resting in bed for a day, to go about on crutches, without bearing any weight on the foot until the third day after the accident. The treatment in the meanwhile consists in immersing the sprained ankle alternately, first in hot water for five minutes and then in cold water for five minutes, followed by rubbing of the parts about the injured joint with chloroform liniment for fifteen minutes, but not at the beginning touching the joint itself. The rubbing should be done by an assistant very gently the first day, with gradual[Pg 69] increase in vigor as the days pass, not only kneading the ankle but moving the joint.

This treatment should be pursued once daily, and followed by bandaging with a flannel bandage cut on the bias three and a half inches wide. With this method it is possible for the patient to regain the moderate use of the ankle in about two or three weeks.

The same general line of treatment applies to the other joints; partial rest and daily bathing in hot and cold water, rubbing and movements of the joint by an assistant. Since sprains vary in severity it follows that some may need only the first day's preliminary treatment prescribed to effect a cure, while others may require fixation by a surgeon in a plaster-of-Paris splint for some time, with additional treatment which only his special knowledge can supply.

This picture shows an excellent method of fixing a sprained joint, used by Prof. Virgil P. Gibney, M.D., Surgeon-in-Chief of the N. Y. Hospital for Ruptured and Crippled. It consists of strapping the joint by means of long, narrow strips of adhesive plaster incasing it immovably in the normal position. This procedure may be followed by anyone who has seen a surgeon practice it.

SYNOVITIS—Severe Injury.—Generally of ankle or knee from fall, or shoulder from blow.

First Aid Rule 1.—Provide large pitcher of hot water and large pitcher of cold water and basin. Hold[Pg 70] joint over basin; pour hot water slowly over joint. Return this water to pitcher. Pour cold water over joint. Return water to pitcher. Repeat with hot water again, and follow with cold. Continue this alternation for half an hour.

Rule 2.—Put to bed, with hot-water bottles about joint, and wedge immovably with pillows.

Rule 3.—When tenderness and heat subside, strap with adhesive plaster in overlapping strips.

Conditions, Etc.—This condition, which may affect almost any freely movable joints, as the knee, elbow, ankle, and hip, is commonly caused by a wrench, blow, or fall. Occasionally it comes on without any apparent cause, in which case there is swelling and but slight pain or inflammation about the joint. We shall speak of synovitis of the knee ("water on the knee"), as that is the most common form, but these remarks will apply almost as well to the other joints. In severe cases there are considerable pain, redness and heat, and great swelling about the knee. The swelling is seen especially below the kneepan, on each side of the front of the joint, and also often above the kneepan. Frequently the only signs of trouble are swelling with slight pain, unless the limb is moved.

Treatment.—If the knee is not red, hot, or tender to the touch, it will not be necessary for the patient to remain in bed, but when these symptoms are present a splint of some sort must be applied so that the leg[Pg 71] is kept nearly straight, and the patient must keep to his bed until the heat, redness, and tenderness have subsided. In the meantime either an ice bag, hot poultice, cloths wrung out in hot water, or a hot-water bag should be kept constantly upon the knee.

A convenient splint consists of heavy pasteboard wet and covered with sheet wadding (or cotton batting) shaped and affixed to the back of the leg, from six inches below to four inches above the joint, by strips of adhesive plaster, as shown in the illustration, and then by bandage, leaving the knee uncovered for applications. A wooden splint well padded may be used instead.

In mild cases without much inflammation, and in others after the tenderness and heat have abated, the patient may go about if the knee is treated as follows: a pad of sheet wadding or cotton batting about two inches thick and five inches long and as wide as the limb is placed in the hollow behind the knee, and then the whole leg is encircled with sheet wadding from six inches below to four inches above the knee, covering the joint as well as the pad. Beginning now five inches below the joint, strips of surgeon's adhesive plaster, an inch wide and long enough to more than encircle the limb, are affixed about the leg firmly like garters so as to make considerable pressure. Each strip or garter overlaps the one below about one-third of an inch, and the whole limb is thus incased in plas[Pg 72]ter from five inches below the knee to a point about four inches above the joint.

An ordinary cotton bandage is then applied from below over the entire plaster bandage. When this arrangement loosens, the plaster should be taken off and new reapplied, or a few strips may be wound about the old plaster to reënforce it. The patient may walk about with this appliance without bending the knee.

When the swelling has nearly departed, the plaster may be removed and the knee rubbed twice daily about the joint and the joint itself moved to and fro gently by an attendant, and then bandaged with a flannel bandage. Painting the knee with tincture of iodine in spots as large as a silver dollar is also of service at this time. The knee should not be bent in walking until it can be moved by another person without producing discomfort.

Such treatment may be applied to the other joints in a general way. The elbow must be fixed by a splint as recommended for dislocation of the joint (p. 128). The ankle is treated as advised for sprain of that joint (p. 68). When a physician can be obtained no layman is justified in attempting to treat a case of water on the knee or similar affection of other joints.

BUNION AND HOUSEMAID'S KNEE.—Bunion is a swelling of the bursa, or cushion, at the first joint of the great toe where it joins the foot. It may not give much trouble, or it may be hot, red, tender, and very painful. It is caused by pressure of a tight[Pg 73] boot which also forces the great toe toward the little toe, and thus makes the great toe joint more prominent and so the more readily injured.

A somewhat similar swelling, often as large as an egg, is sometimes seen over the kneepan, more often in those who work upon their knees, hence the name housemaid's knee. The swelling may come on suddenly and be hot, tender, and painful, or it may be slow in appearing and give little pain.

Treatment.—The treatment for the painful variety of bunion and housemaid's knee is much the same: absolute rest with the foot kept raised, and application of cloths kept constantly wet with ice or cold water; or a thick covering of Cataplasma Kaolini (U. S. P.) may be applied until the inflammation has subsided. If the trouble is chronic, or the acute inflammation does not soon abate under the treatment advised, the case is one for the surgeon, and sometimes requires the knife for abscess formation. In the milder cases of bunion, wearing proper shoes whose inner border forms almost a straight line from heel to toe, so that the great toe is not pushed over toward the little toe, and painting the bunion every few days with tincture of iodine, until the skin begins to become sore, will often be sufficient to secure recovery.

RUN-AROUND; WHITLOW OR FELON.—"Run-around" consists in an inflammation of the soft parts about the finger nail. It is more common in the weak, but may occur in anyone, owing to the entrance[Pg 74] of pus germs through a slight prick or abrasion which may pass unnoticed. The condition begins with redness, heat, tenderness, swelling, and pain of the flesh at the root of the nail, which extends all about the nail and may be slight and soon subside, or there may be great pain and increased swelling, with the formation of "matter" (pus), and result in the loss of the nail, particularly in the weak.

Whitlow or felon is a much more serious trouble. It begins generally as a painful swelling of one of the last joints of the fingers on the palm side. Among the causes are a blow, scratch, or puncture. Often there is no apparent cause, but in some manner the germs of inflammation gain entrance. The end of the finger becomes hot and tense, and throbs with sometimes almost unbearable pain. If the inflammation is chiefly of the surface there may be much redness, but if mainly of the deeper parts the skin may be but little reddened or the surface may be actually pale. There is usually some fever, and the pain is made worse by permitting the hand to hang down. If the felon is on the little finger or thumb the inflammation is likely to extend down into the palm of the hand, and from thence into the arm along the course of the tendons or sinews of the muscles. Death of the bone of the last finger joint necessitating removal of this part, stiffness, crippling, and distortion of the hand, or death from blood poisoning may ensue if prompt surgical treatment is not obtained.

[Pg 75]Treatment.—At the very outset it may be possible to stop the progress of the felon by keeping the finger constantly wet by means of a bandage continually saturated with equal parts of alcohol and water, at night keeping it moist by covering with a piece of oil silk or rubber. Tincture of iodine painted all over the end of the finger is also useful, and the hand should be carried in a sling by day, and slung above the head to the headboard of the bed by night. If after twenty-four hours the pain increases, it is best to apply hot poultices to the finger, changing them as often as they cool. If the felon has not begun to abate by the end of forty-eight hours, the end of the finger must be cut lengthwise right down to the bone by a surgeon to prevent death of the bone or extension of the inflammation. Poultices are then continued.

"Run-around" is treated also by iodine, cold applications, and, if inflammation continues, by hot poulticing and incision with a knife; but poulticing is often sufficient. Attention to the general health by a physician will frequently be of service.

WEEPING SINEW; GANGLION.—This is a swelling as large as a large bean projecting from the back or front of the wrist with an elastic or hard feeling, and not painful or tender unless pressed on very hard. After certain movements of the hand, as in playing the piano or, for example, in playing tennis, some discomfort may be felt. Weeping sinew sometimes interferes with some of the finer movements of the hand. The[Pg 76] swelling is not red or inflamed, but of the natural color of the skin. It does not continue to increase after reaching a moderate size, but usually persists indefinitely, although occasionally disappearing without treatment. The swelling contains a gelatinous substance which is held in a little sac in the sheath of the tendon or sinew, but the inside of the sac does not communicate with the interior of the sheath surrounding the tendon.