DUPLICATE 
 
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 IRST 
 
 Accident 
 
 AND 
 
 UDDEN LLNESS 
 
 
 ' BY 
 
 GEORGE BLACK, M.B.,EDiN 
 
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 Reference Library 
 
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 COLLEGE OF PHYSICIANS 
 AND SURGEONS 
 
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 horiM be walked about 
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 ' young ehil- 
 great risk, 
 popular 
 entities, 
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 W: 
 
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a, the frontal 
 hone; b, theorhit; 
 c, the teeth ; d, the 
 tempero - parietal 
 suture; e,thezygo- 
 tnatic arch ; £, the 
 cervical vertebra ; 
 g, the shoulder 
 girdle; h., the cora- 
 coid process of sea- 
 pula; k, the ster- 
 num, or breast 
 hone ; 1, the lower 
 rihs ; m, the hume- 
 rus; n, the ulna; 
 o, the radius ; p, 
 
 ca/fpus or wrist ; q, 
 the fingers ; r, the 
 himhar vertehrce; 
 — 72/ S)the sacrum; t, 
 the crest of the 
 ilium; u, the great 
 trochanter of the 
 femur, or thigh 
 hone ; V, the shaft 
 of the femur; w, 
 the tibia, or shin 
 hone; x,the fibula; 
 y, the patilla, or 
 Tcnee pan ; z, the 
 heel ; 1, the tarsus; 
 2, the metatarsus. 
 
 Fig. 1.— The Human Skeleton. 
 
FIEST AID: 
 
 A LOOK OF READY REFERENCE IX TIIIES 
 OF EilERGEXCY, 
 
 A MAlSrUAL OF INSTRUCTION FOR 
 AMBULANCE STUDENTS, 
 
 AND A 
 
 PLAIX PEACTICAL GUIDE 
 
 TO TEE KENDERING OF HELP IX CASE OF ACCIDENT 
 OR SUDDEN ILLNESS. 
 
 BY 
 
 GEOEGE BLACK, M.B., Edtn., 
 
 AtTTHOE OF "THE YOUifG WIFE'S ADVICE BOOK," ETC. 
 
 WARD, LOCK, AND CO., 
 
 LONDON: WARWICK HOUSE. SALISBURY SQUARE, E.G. 
 
 NEW YORK: BOND STREET. 
 
 lAll rigTits reserved.} 
 
Digitized by tine Internet Arcinive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/firstaidbookofreOOblac 
 
CONTENTS. 
 
 -»o»- 
 
 Tinr. 
 
 INTRODUCTION 7 
 
 GENERAL OUTLINE OF THE ANAT0:MY AND 
 
 PHYSIOLOGY OF THE HUMAN BODY. 
 
 BONES U 
 
 MUSCLES 21 
 
 THE NERVOUS SYSTEM 27 
 
 THE VASCULAR SYSTEM 37 
 
 THE CIRCULATION OF THE BLOOD 42 
 
 THE LUNGS AND RESPIRATION 4G 
 
 THE SKIN AND ITS APPENDAGES 53 
 
 SOURCES or GAIN AND LOSS CO 
 
 THE GLANDS OP THE BODY Co 
 
 DISEASES AND ACCIDENTS 
 
 rOE -SVHICH FIPwST AID MAY BE EEQUIEED. 
 
 BRUISES C9 
 
 WOUNDS 71 
 
 Lacerated "Wounds 73 
 
 Perforatixg WouMis 75 
 
 Gunshot "Wounds 77 
 
 Poisoned Wounds 79 
 
 Stings of Insects and Bites troii Vipers .... SI 
 
 Bites by a Mad Dog or other Animal .... S3 
 
 HEMORRHAGE S4 
 
 Bleeding from "Wounds S5 
 
 Bleeding prom the Nose 94 
 
 Bleeding after Application of Leeches .... 94 
 
 Bleeding after Extraction of a Tooth .... 95 
 
 Bleeding after Confinement 95 
 
 Bleeding from the Umbilical Cord 96 
 
 Bleeders 9G 
 
 Internal Bleeding 97 
 
VI CONTENTS. 
 
 TAGE 
 
 LOSS OF CONSCIOUSNESS 98 
 
 Fainting 99 
 
 Hysteria 101 
 
 Fits 103 
 
 Infantile Convulsions 105 
 
 Uremic Convulsions 107 
 
 Loss op Consciousness prom Apoplexy .... 108 
 
 Loss of Consciousness from Intoxication .... 109 
 
 Loss of Consciousness from Concussion of the Brain . 110 
 
 FOREIGN BODIES IN THE NOSE 112 
 
 FOREIGN BODIES IN THE EAR 114 
 
 FOREIGN BODIES IN THE EYE 117 
 
 CHOKING 121 
 
 SPURIOUS CROUP 126 
 
 CROUP 127 
 
 SPRAINS 129 
 
 DISLOCATIONS 132 
 
 FRACTURES 140 
 
 SCALDS AND BURNS 145 
 
 COLD, CHILBLAINS, FROST BITE, &c. . . . . 151 
 
 DROWNING 156 
 
 EXCESSIVE HEAT 167 
 
 SUFFOCATION 169 
 
 POISONS 172 
 
 Emetics 175 
 
 Irritants . 177 
 
 Corrosives 183 
 
 Alkalies . 184 
 
 Narcotics 185 
 
 Shell-Fish 188 
 
 Poisonous Fungi 188 
 
 Other Poisons, not Classified 189 
 
 TRANSPORT 191 
 
 BANDAGING 197 
 
INTEODUCTIOK 
 
 Within the last few years Ambulance Work lias 
 made rapid strides in this country, centres have been 
 established in the principal towns in connection with 
 the St. John's Association, and Lectures on First 
 Aid have become a part of each winter's programme 
 in every city, town, and even village, throughout the 
 land. 
 
 The interest which this subject has excited is very 
 real and widespread, as may be seen from the thou- 
 sands of both sexes who annually appear for in- 
 struction in connection with these classes. 
 
 Medical men everywhere have thrown themselves 
 into the work with great spirit, and the interest 
 they display in these classes can only arise from a 
 belief that they supply a long felt want which they, 
 perhaps, were most conscious of. 
 
 The work of the physician and surgeon have for 
 Ions: demonstrated the fact that there is a wide field 
 of usefulness outside their own special sphere, in 
 which those who have been instructed can find ample 
 scope for the exercise of the knowledge they possess. 
 
 Disease may be sudden in its onset, accidents may 
 happen at any time, medical aid is not always at 
 hand, and lives have doubtless been jeopardised or 
 
8 INTEODUCTIO:S". 
 
 sacrificed many a time from ignorance on tlie part of 
 those immediately concerned. 
 
 At such a time to know the right thing to do, 
 and be able to do it, must be a source of great 
 satisfaction, and only those who have been brought 
 face to face with the real danger, and have had to 
 deplore their inability to help on account of want of 
 previous training, or medical men who had keenly 
 felt the want of an intelligent appreciation in regard 
 to the rendering of First Aid, can fully appreciate the 
 benefit that has accrued to society from the diffusion 
 of this kind of knowledge. 
 
 Many older people can doubtless recall instances 
 in wdiich the knowledge possessed by their sons and 
 daughters would have proved of great value to them, 
 but where fear, begotten of ignorance, paralysed 
 their efforts. 
 
 Perhaps, however, it was better so, than tha;t 
 their want of knowledge should make them fool- 
 hardy as one sometimes sees, and cause them to do 
 irreparable mischief. 
 
 If instruction, such as is given in ambulance 
 classes, has a tendency to make people helpful to one 
 another and society, the better for the diffusion of 
 such knowledge ; it has also the effect of preventing 
 them encroaching on the domain of the medical man. 
 
 In country districts, where medical aid is not so 
 easily procurable as in towns, and where the 
 doctor's fee is a matter of some consideration, there 
 may be found a boldness, the outcome of ignorance 
 
INTRODUCTION. 9 
 
 and prejudice, Avliicli causes both astonishment and 
 regret. 
 
 There is a wide field of usefulness, in which material 
 help can be rendered and by which much suffering 
 may be spared, lives may be saved, and the work of 
 the medical man simplified and made more potent 
 for good. 
 
 The recognition of this has led to a demand for 
 manuals of instruction in connection with the work 
 that is going on. Oral instruction is exceedingly 
 useful, but it requires to be supplemented by other 
 kinds, and the present book aims at occupying a 
 place as text-book and manual of reference to the 
 ambulance student. 
 
 It is hardly necessary to point out the instances in 
 which First Aid may be called for, they will sug- 
 gest themselves to the mind of the reader, but I 
 have endeavoured, in the following pages, to avoid 
 technicahties, and treat each ^^art of the subject as 
 clearly and popularly as it was in my power to do. 
 
FIRST AID 
 
 IN 
 
 ACCIDENT AND SUDDEN ILLNESS, 
 
 GENERAL OUTLINE 
 
 OF THE 
 
 ANATOMY & PHYSIOLOGY OF THE HUMAX BODY. 
 
 BONES. 
 The skeleton, as its name implies, signifies the 
 dry or hard parts of the body. These constitute the 
 foundation or frame-work of the human structure. 
 They give support to the soft parts, and surround 
 and give protection to the more delicate and vital 
 organs of life — such as the brain, spinal marrow, 
 heart and lungs. They also give attachment to the 
 different muscles by which the varied movements of 
 the body are brought about. 
 
 Bones consist of two parts, an animal, or organic, 
 and an earthy, or inorganic, but the proportion is 
 altered at different periods of life. In childhood, the 
 former is equaJ in amount to the latter, but as age 
 advances the earthy matter predominates, rendering 
 the bones more brittle and liable to fracture. In 
 some diseases, such as rickets and scrofula, a diminu- 
 tion of the earthy matter takes place, causing the 
 bones to become bent and curved, either on account 
 of the action of certain muscles, or because of the 
 
12 . BONES. 
 
 limbs bending under their own weight or the super- 
 incumbent weight of the body. 
 
 The mimher of bones in the human body varies at 
 different periods of life, there being more in childhood 
 than in old age. In the adult there are 206, including 
 the small bones of the ear. They are as follows : — 
 Skull, 8 ; face, 14 ; small bones of the ear, 6 ; spine, 
 26 ; ribs, breast-bone, and hyoid-bone, 26 ; the upper 
 extremities, consisting of collar-bone, shoulder-blade, 
 cubit or arm-bone, bones of the forearm, carpal, 
 metacarpal, and the digits, 64 ; the lower extremities, 
 consisting of pelvis, thigh-bone, knee-pan, bones of 
 the leg, tarsal and metatarsal bones, and the digits, 62. 
 
 Bones are divided into different classes— viz., long, 
 short, flat, and irregular. 
 
 Long bones consist of a shaft and two extremities, 
 the latter of which are covered with cartilao^e to 
 enable them to move more easily upon each other 
 and act as buffers in dimishing shock, while friction 
 is lessened by the presence of a delicate synovial 
 membrane, which secretes a lubricating fl.uid, 
 called synovia or joint-oil. The chief long bones are 
 the cubit or arm-bone, the two bones of the forearm, 
 the thigh-bone, the shin and splint bones, the bones 
 of the fingers and toes, and the collar-bone. 
 
 The short bones do not admit of the same amount 
 of motion as the long bones. They are strong and 
 compact in their structure, and occupy positions in the 
 body where strength and a limited amount of move- 
 
BONES. 13 
 
 ment are required. The wrist and the bones of the 
 ankle and instep are examples of this class of bone. 
 
 Instances of flat bones are found in the skull 
 blade-bones, haunch-bones, breast-bone, and ribs. 
 They protect cavities, and afford broad surfaces for 
 the attachment of muscles. 
 
 In the class of irreg-nlar bones are placed those 
 which are not included in the classes already men- 
 tioned ; for example, the spine, jaw-bones, &c. 
 
 The skxill consists of eight bones, tightly knit 
 
 Fig. 2.— The Skl'll. 
 
 a, t"he frontal bone ; h, the parietal ; c, the temporal ; d, the inferior 
 maxillarj', or lower jaw bone ; e, the superior maxillary bone ; /, the 
 malar bone ; g, mastoid process of temporal bone. 
 
 together by saw-like edges called sutures. These 
 bones consist of an outer tough, fibrous part, and an 
 inner hard and glassy, with a soft, spongy portion 
 between. It is divided into two parts, the cranium 
 and the face. The cranium is that part which 
 protects the brain. The face is composed of four- 
 teen bones, twelve of which are in pairs. It contains 
 the organs of special sense— the eye, the ear, the 
 nose, and the tongue. 
 
14 
 
 BONES. 
 
 The spinal column may be regarded as the 
 fundamental part of the skeleton, 
 inasmuch as it is never absent 
 from any animal that has an 
 osseous system. It is the centre 
 round which the other parts are 
 developed and arranged. It is 
 a pillar of support to the rest 
 of the body, carrying on its 
 summit the head, on its sides 
 the ribs, and through them the 
 arms, and it transmits the 
 v^eight of the trunk, by resting 
 upon the pelvis, to the lower 
 limbs. It also contains and 
 >■ ^M protects the spinal marrow. In 
 ^^ a ^y structure it is composed of a 
 number of segments, called 
 vertebrse, which are united to 
 one another by elastic pads 
 which act as buffers, warding 
 off jars in jumping or falling, 
 and permitting a considerable 
 ^i^^vD\ § amount of movement in stoop- 
 
 ing, bending backwards, and 
 rotating the body. In the adult 
 twenty-six bones enter into the 
 composition of the spine. In the 
 ^ ,^— child there are thirty-three, five 
 
 becoming united, as life advances, into one mass 
 
 ^r 
 
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 a 
 
 B 
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 5 i 
 
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B0NE8. 
 
 15 
 
 to fonn tlie bone called the sacrnm, while other four 
 go to make up the coccyx. 
 
 The chest has in front the breast-bone or sternum, 
 behind the spine and on either side the ribs, of which 
 there are twelve pairs — seven true and five false. 
 
 ■The Trunk. 
 
 a, the Atlas vertebra ; h, the axis vertebra ; c, the seventh or last cervical 
 vertebra ; d, the first dorsal vertebra ; e, the last dorsal vertebra ; /, the 
 first lumbar vertebra ; g, the last lumbar vertebra ; h, the sternum, or 
 breast-bone ; i, the first rib ; Jc, the eleventh rib ; I, the twelfth or last 
 rib; m, the costal cartilages; n, the clavicle, or collar bone; o, the 
 acromion process of the scapula; p, the glenoid cavity of the scapula for 
 articulation with the head of the humerus. 
 
 In it are placed the principal organs of respiration 
 and circulation, such as the lungs and heart. It 
 
IC 
 
 BONES. 
 
 is separated from the abdominal cavity by means of 
 a flesliy partition, called tlie diaphraGim. 
 
 The upper limb con- 
 sists of the clavicle or 
 collar-bone, the scapula 
 or blade-bone, the hu- 
 merus or bone of the 
 upper arm, the radius 
 and ulna or bones of 
 the forearm, the eight 
 bones which form the 
 vnrist, the hand with its 
 five bones, and the 
 digits or fingers, con- 
 sisting of fourteen bones 
 termed phalanges. The 
 upper limb admits of 
 freer movement than 
 the lower, on account 
 of the shallowness of 
 the ball and socket 
 attachment of the arm 
 to the shoulder-blade, 
 in virtue of which dis- 
 location of this joint is 
 of very frequent occur- 
 rence. 
 
 The pelvis, so called from its fancied resemblance 
 to a basin, is an irregular structure formed by the 
 
BONES. 
 
 17 
 
 two hauncli-bones, called ossa innominata, the 
 sacrum, and coccyx. Each os innominatum is 
 separable into three bones called pubis, ischium, 
 
 Fig. 6. — The Human Pelvis, 
 
 y y, the sympliysis pubis ; Ic, descending ramus of pubis ; h, obturator 
 foramen ; vi, n, o, ridge forming lower boundary of internal iliac fossa ; 
 u, y, u, notch presented by great peMs ; d, promontory of sacrum ; i and t, 
 internal iliac fossae ; g, d, circumference of pelvic brim ; m, u, anterior 
 edge of base of sacrum ; n, o,_ horizontal ridge ; o, spine of pubis; x, y, z, 
 arch of pubis ; ^l, v, crest of ilium. 
 
 and ilium, in the young. It sup23orts the spine and 
 connects the trunk with the lower limbs by means of 
 strong but flexible joints. 
 
 Vm. 7.— The Eight Foot. 
 
 a, the OS calcis ; h, the astragalus ; c, the scaphoid ; d, the cuboid ; 
 e, the three cuneiform bones j /, the metatarsus j g, the toes. 
 
18 
 
 BONES. 
 
 tc ,„ 
 
 The lo'ver limlb consists of the thigh-bone, the head 
 of which is sunk deeply in a cor- 
 responding cavity in the pelvis, 
 the patella or knee-pan forming 
 the projection of the knee and 
 l^rotecting the joint, the tibia or 
 principal bone of the leg, the 
 lower end of which forms the 
 projection at the inner ankle, 
 the fibula or splint-bone, and the 
 foot, which consists of twenty-six 
 small bones, of which seven form 
 the tarsus (heel and instep), five 
 the middle of the foot, and 
 'Aket § '-^ S ® fourteen the toes. 
 
 ^ .„ ®;^ 
 
 o 5> 
 
 m 
 
 /^ 
 
 The Joints. 
 
 ^ 3^g 
 
 The various bones of which the 
 skeleton is composed are con- 
 nected together by means of 
 membranous bands, called liga- 
 ments, b}^ which the movements 
 of the body are enabled to take 
 place. Movement is not possible 
 to the same extent in all, and in 
 those joints called synartlirodial, 
 such as we have formed between 
 the various bones of the skull, 
 it is of a very limited nature. In 
 another class, the amj[)hiarthrodial, there is greater 
 
 
BONES. 
 
 19 
 
 freedom of movement than in tlie synartlirodial, but 
 still it is only movement confined within a narrow 
 limit ; as an example of the joint we have the arti- 
 culation of the various vertebrce which go to form 
 the spine. 
 
 The greatest amount of movement is seen in the 
 
 diartlirodial or true joint, of which the shoulder and 
 hip are examples. Here we have the two surfaces 
 of the bones whch come into contact protected by a 
 firm plate of cartilage, which has a smooth and 
 polished surface, and friction between the two sur- 
 faces is diminished by means of the joint oil or 
 synovial fluid, which is secreted by the delicate 
 
20 BONES. 
 
 synovial membrane which lines the cavity of the 
 joint, with the exception of that part which is covered 
 
 Fig. H.—The Knee Joint looked at from Behind. 
 
 with cartilage. This form of joint is further 
 strengthened by ligamentous bands, and bands of 
 
 Fig. 12. — The Human Pelvis looked at prom Before. 
 a, the sacrum; &, ilium; c, iliac crest; d, pubis; e, ischium j 
 /, tuberosity of ischium ; g, head of femur, or thigh-bone ; h, capsular 
 ugament. 
 
 fibrous tissue extending between and around the 
 bones. 
 
MUSCLES. 
 
 21 
 
 ]\nJSCLES. 
 
 The muscles form that part of the body which is 
 called the flesh. They consist of bundles of fibres, 
 called " fasciculi," and each fasciculus is made up 
 of a number of threads, called fibrils. 
 
 The muscles are surroTinded by connective tissue, 
 forming sheaths, which send prolongations inwards 
 
 Fig. 13.— The Boxes of the Upper ExTKEiriTY, tvith the Brachialis 
 Ajjticus Muscle attached, axd ix a state or Contraction. 
 
 a, the humerus ; h, the ubia j c, brachialis anticus. 
 
 to envelope the bundles of fibres. This connective 
 tissue or sheath of the muscle is extended towards 
 each end into tendons or guides as they are popu- 
 larly called, which are inserted into the bones. 
 
 Iffinscle is possessed of the remarkable property 
 of contractility, for the most part through the in- 
 fluence of the will, but in some instances, as tlie 
 heart, independent of it. 
 
22 MTJSCLES. 
 
 During the contractions of a muscle the lengtli 
 is diminislied, wliile the bulk and breadth are in- 
 creased, and it is by the contraction of the muscles 
 throughout the body and their subsequent relaxation 
 that the wonderful and complex movements tliat 
 are constantly being performed by every indididual 
 are due. The bones are the levers, and it is by the 
 contraction of the different muscles that they are 
 ap^Droximated to one another. 
 
 The influence of the will acting through the nervous 
 system upon the muscles is exceedingly subtle and 
 rapid, and by means of what is called the muscular 
 sense the most delicate movements are rendered 
 possible, and the amount of muscular power that is 
 exerted is carefully regulated according to the 
 requirements of the case. 
 
 Ey habitual practice we come to forget this 
 muscular sense altogether, but occasionally we are 
 roused to a knowledge of its great usefulness when 
 it has been thrown off its guard and we take what is 
 called a false step, as when a person, thinking he 
 has another step of a stair to descend, finds himself 
 on the level and becomes conscious that he has made 
 muscular exertion out of all proportion to the 
 requirements of the case. 
 
 There are altogether upwards of five hundred 
 muscles in the body, which are for the most part 
 arranged in pairs. They are grouped into layers of 
 superficial and deep, but in many places, in order 
 
MUSCLES. 
 
 2a 
 
 Fig. 14. 
 Muscles VIE^YED fkom Behind. 
 
 Fig. 15. 
 Muscles viewed froji Befork, 
 
 a (fig. to left), occipital portion of occipito-frontalis muscle ; a (fig. to 
 right) frontal portion of the same muscle ; h, the muscles of the cheek; 
 c, the sterno-cleido-mastoid muscle; d, the trapezius; e, the pectoralis 
 major; /, the latissimus dorsi; g, the external oblique muscle of the 
 abdomen ; 7i, the gluteus maximus ; 7:, ibe deltoid ; I, the muscles on the 
 posterior- ; I, muscles on the anterior aspect of tlie upper arm ; on, muscles 
 on posterior. ; vi, muscles on anterior aspect of forearm ; n, muscles 
 of the ball of the thumb ; o, muscles of the thigh ; p, muscles of front of 
 leg; g, muscles of calf; r, the tendo Achillis, or tendon of Achilles; 
 s, muscles on upper surface of the foot. 
 
24 MUSCLES. 
 
 to allow of the complicated movements whicli take 
 place, there may be as many as half a dozen different 
 layers, for example, in the back. 
 
 The muscles give grace and symmetry to the 
 body, and in a thin and muscular subject the move- 
 ments of many of the muscles may be studied. 
 Thus, for instance, the contraction of the biceps 
 muscle, which raises the fore-arm to the upper arm 
 and the contraction of the rectus or straight muscle 
 of the thigh which takes place in the act of kicking, 
 and is well seen in the football field. 
 
 Muscles do not always act in a straight up and 
 down way, but if they pass obliquely from one part 
 of the body to another they vdll give rise to a cor- 
 responding oblique action when they contract. This 
 is well exemplified in the sartorius or tailor muscle, 
 which, by its contractions, crosses the legs and gives 
 rise to the familiar position in which tailors sit 
 during their operations. Wliile contractility is the 
 special function of muscles, it must not be forgotten, 
 that relaxation is quite as essential to their harmo- 
 nious working, and that it becomes an exceedingly 
 difficult thing to remain for a length of time in any 
 one position. If anyone doubts this he has but to 
 try how long he can hold his arm out in a straight 
 line from his body, he will soon find that without 
 relaxation it becomes unbearable. 
 
 In some people, such as those of nervous tempera- 
 ment, muscular contraction is frequently rapid and 
 
MUSCLES. 
 
 25 
 
 spasmodic, but they are speedily tired and unable to 
 sustain any long-continued exertion. Those, ao-ain 
 in whom the muscular system is more highly deve- 
 loped, as in athletes, exhibit a capacity for prolonged 
 muscular exertion ; but, usually speaking, they are 
 duller and less sensitive than the other. ^Vhere 
 these two types of constitu- 
 tion are found blended in 
 the same individual we have 
 a frame capable of accom- 
 plishing the very highest 
 feats of mental and physical 
 achievement. 
 
 Some muscles, such as the 
 heart, the muscles of the 
 stomach, and the intestines, 
 are independent of the action 
 of the will, and continue 
 their contraction and relaxa- 
 tion during sleep, as when 
 the individual is awake. 
 
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 tc C S 
 
 
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 ££; ro «i Qj 
 
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 r=; or-- ■-. 
 
 I 
 
 o 
 
 I— I 
 
 d 
 
 5 ~ ^ 2 
 
 = ? =' 3 
 ^ - '^ 2 
 
 ^^ Pi ft 
 
 Wheu a muscle is taken 
 out of the body, and is deprived of its blood, a semi- 
 transparent fluid may be squeezed out of it, which 
 undergoes coagulation on exposure to the air. The 
 same thing happens within the muscles after death, 
 and gives rise to the death stiffening, ov rig oi^ mortis, 
 as it is called, with which most people are familiar. 
 
26 . MUSCLES. 
 
 The muscles of the body are only capable of per- 
 forming tlieir wonderful feats of strength in virtue 
 of life, and the influence of the nervous system upon 
 them. After death a muscle which, during life, was 
 capable of contracting with a force equal to the 
 weight of a hundred pounds, will be broken when 
 out of the body by a weight of ten. 
 
THE NERVOUS SYSTEM. 
 
 27 
 
 THE NEEYOUS SYSTEM. 
 
 The nervous system is the most complicated of all 
 the systems in the body. Complex in its structure, 
 and in its manifestations, the seat of the intellect, 
 the will, and the moral faculties ; it is the abode of 
 all that is noblest and greatest in man. Through it 
 he suffers pain, through it is his capacity for enjoy- 
 
 FiG. 17.— Vertical Sectiox through the Skull, displayixg Right 
 Half of the Brain. 
 
 a, frontal lobe ; h, parietal lobe ; c, occipital lobe ; d, the cerebellum ; 
 e, medulla oblongata ; /, the spinal cord : g, the pons Varolii ; h, the corpus 
 callosum ; i, the fifth ventricle ; k, the third ventricle ; Z, the tentorium 
 cerebellij ?7i, the frontal sinus; n, perpendicular plate of the ethmoid 
 bone; 0, the nasal cartilage; p, the superior maxillary bone; r, the 
 Eustachian tube; s, the soft palate ; q, the pharynx. 
 
 ment, and it is the originator and controller of his 
 every thought and action — of all that gives him the 
 superior position in the world that he enjoys. 
 
28 THE NERVOUS SYSTEM. 
 
 The nervous system consists of two parts, one 
 wliitisli and opaque, consisting of fibres, and the 
 other redish-grey, and consisting of granular matter 
 made up in the form of cells. The principal divi- 
 sions are the cerebro-spinal axis, consisting of the 
 brain and spinal cord, and the sympathetic. 
 
 FtG. 18. — The Base of the Bhain. 
 
 a, the anterior lobe ; b, the middle lobe ; c, the occipito-parietal 
 fissure ; d, the cerebellum ; e, the medulla oblongata ; /, the pons Yarolii ; 
 g, optic commissure J li, bulb of the olfactory nerve ; i, crus cerebri. 
 
 The Brain is contained in the cavity of the skull, 
 and is surrounded by a dense fibrous structure called 
 the dura mater. It is divided into two parts, called 
 hemispheres, by a longitudinal fissure running from 
 before backwards, each of which has a folded appear- 
 ance, and is composed of a number of convolutions 
 separated one from another by grooves or fissures. 
 
THE NERVOUS SYSTEM. 
 
 29 
 
 In proportion to his size, the brain is much more 
 largely developed in man than in the lower animals, 
 being equal to one-fortieth of his entire weight, as 
 
 Fig. 19. — The Base of the Brain. 
 
 1, the olfactory nerve ; 2, the optic nerve ; 3, the third pair of nerves ; 
 4, the fourth pair of nerves ; 5, the trigeminus ; 6, the sixth pair ; 7, the 
 seventh pair ; 8, the eighth pair ; 9, the ninth pair ; a, superior convolution 
 of cerebrum; c, middle convolution ; ?), occipital lobe ; d, pons Varolii ; 
 e, medulla oblongata ; /, crura cerebri ; g, anterior part of square lobe of 
 cerebellum ; h, the anterior perforated spot ; i, the inf undibulum ; u, the 
 tuber cinerium ; z, the corpora albicantia ; t, the commissure ; I, under 
 surface of cerebellum ; x, the longitudinal fissure ; m, the flocculus ; 
 n, the notch between the hemispheres ; y, convolutions of the cerebrum, 
 
 compared with one-thousandth in the whale. It is 
 larger in man than in woman, and varies consider- 
 
 Its average weight in 
 
 ably in different individuals. 
 
30 
 
 THE NERVOUS SYSTEM, 
 
 tlie adiilt male is from 49 to 50 ounces. In some 
 men of great intellectual power it has attained to 
 63 and 64 ounces, but tlie greatness of tlie intellect 
 is not always proportionate to the size and weight 
 of the brain, some men of very remarkable power 
 having small brains, and some idiots having very 
 large ones. 
 
 Fiu. 20. — The Left Half of the Brain. 
 
 Z, lateral wall of tHird ventricle ; e, d, f, curve of corpus callosum ; 
 t, septum lucidum ; Jc, fornix ; z, corpora albicantia ; h, tuber cinerium ; 
 t, the infundibulum ; 2, the optic nerve ; c, section of the anterior 
 commissure ; x, section of posterior commissure ; p, the pineal gland ; 
 s, the peduncle of the pineal gland ; o, the pons Varolii ; g, medulla 
 oblongata; y, opening in lower part of fourth venti-icle ; I, v, aqueduct of 
 Sylvius ; /, g, corpora quadrigemina ; s, superior peduncles of pineal gland ; 
 r>, above this is the posterior part of floor of third ventricle ; m, anterior 
 part of floor of third ventricle ; w, arbor vitse of middle lobe of cere- 
 bfllum; o/j opening establishing a communication between the general 
 ventricular cavity and the spinal subarachnoid space ; g, lo, the valve of 
 Vieussens. 
 
 From the brain, through openings in the skull, 
 
 called foramina, pass the nerves of special sense, 
 
 such as those of sight, taste, and smell. While the 
 
 brain is the seat of sensation, and injuries to it 
 
 may be followed by paralysis of different parts of 
 
 the body, it is yet not sensitive to pain, nor is the 
 
THE NERVOUS SYSTEBI. 31 
 
 removal of portions of it necessarily followed by 
 death. Eabbits and pigeons have had their brains 
 removed, and have yet continued to live. The part of 
 the nervous system of greatest vitality, because of the 
 important centres which have their seat in it, is the 
 medulla oblongata, or that part of the cerebro-spinal 
 axis which serves by some of its fibres as a connect- 
 ing link between the spinal-cord and the little brain 
 or cerebellum, and by others as a bond of union 
 between the spinal cord and the brain proper. Here 
 
 Fig. 21.— Upper Surface of OEREBELiusr. 
 
 a, anterior or square lobej 6, posterior superior lobe; c, posterior 
 inferior lobe. 
 
 the centres concerned in respiration, swallowing, &c., 
 have their seat, and injury to this part is imme- 
 diately fatal. 
 
 The Pons Varolii, or bridge of Yarolius, is that 
 part which connects the various portions of the great 
 and little brain together. 
 
 The muscular system in man is capable of the most 
 complex and varied movements, and it would appear 
 that the cerebellum, or little brain, is concerned 
 in combining and harmonising these move- 
 
32 
 
 THE NERVOUS SYSTEM!. 
 
 ments. That this is the case, 
 is made pretty evident from the 
 fact that when the cerebellum has 
 been removed from an animal it 
 loses the power of regulating its 
 movements, and reels and staggers 
 like a person under the influence of 
 drink, and the same inability to 
 combine and control the action of 
 his muscles is seen in an individual 
 who suffers from disease of this 
 structure. 
 
 l\/ 
 
 
 ft 
 
 The spinal cord is contained in 
 the spinal canal of the vertebrae, 
 is surrounded by a fibrous sheath, 
 and is composed, like the brain, 
 of a grey portion and a white. 
 Thirty-one pairs of nerves are given 
 off by the spinal cord, which pass 
 for the most part to supply the 
 muscles and skin of the body. 
 
 Each, nerve is made up of two 
 
 parts, an anterior and a posterior 
 root, and the wonderful thing about 
 these is tha^t the one is sensory and 
 the other motor — that is to say, the 
 former is concerned in conveying 
 impressions from the surface of the 
 body to the brain, and the latter 
 
THE NERVOUS SYSTEM. 
 
 33 
 
 in carrjang messages 
 from the brain to the 
 mnscles. This may 
 be shown in the 
 following way : if 
 the anterior root 
 be divided, and the 
 end farthest removed 
 from the cord be 
 irritated, movement 
 will result, but no 
 pain will be felt ; if, 
 on the other hand, 
 the posterior root be 
 similarly treated, no 
 contraction of the 
 muscles supplied by 
 the nerve will take 
 place, but if the end 
 next the spinal cord 
 be irritated, intense 
 pain will be experi- 
 enced. 
 
 If the spinal cord 
 be divided, or what 
 amounts to pretty 
 much the same thing, 
 if, as the result of an 
 injury, it is severely 
 
u 
 
 THE NER70TJS SYSTEM. 
 
 crushed at any one point, paralysis of the parts 
 below tlie seat of injury takes place, and although 
 
 '-« 
 
 Fig. 24.— Superficial Distribution of the Facial, the Fifth or 
 Trigeminal, and other Nerves. 
 
 a, the infra-orbital nerve ; h, the two divisions of the frontal nerve ; 
 c, the au I iculo -temporal nerve ; d, superficial distribution of the outer and 
 inner divisions of the mental branch of the inferior dental nerve ; e, the 
 trunk of the facial nerve after its exit from the stylo-mastoid foramen ; 
 /, the great occipital nerve ; g, the superficial cervical, great auricular, and 
 lesser occipital nerves. 
 
 what is called reflex action remains (that is to 
 say, if you tickle the soles of the feet there will 
 
THE NERVOUS SYSTEM. 35 
 
 be muscular contractions, giving rise to jumping 
 and starting of the limb that is tickled), the person 
 will feel nothing. 
 
 The sjrmpathetic nerve consists of a series of 
 swellings called ganglia, which are formed into a 
 double chain lying in front of the spinal column, one 
 on eitlier side of the vertebi-se. The action of this 
 nerve is independent of the will, and the parts 
 supplied by it, such as the heart, the lungs, and the 
 viscera, continue to perform their functions durino* 
 sleep, just as when the person is awake. 
 
 The brain and different parts of the nervous system 
 have been comj^ared by some writers to a telegraph 
 department, the brain constituting the central oihce, 
 the spinal cord the sub-offices, and the different nerves 
 rej)resenting its wide-spread ramifications. By this 
 system messages are constantly conveyed from the 
 brain to different parts of the body, and from the 
 different parts of the body along the nerves back 
 to the brain, and in this way the individual acts on his 
 surroundings, and is reacted upon by them in turn. 
 
36 
 
 THE VASCULAR SYSTEM. 
 
 THE VASCULAR SYSTEM. 
 
 Behind the hreast "bone and between the lungs, 
 but rather more to the left than to the right side, 
 lies the great force-pump or principal organ con- 
 cerned in the circulation of the blood, the heart. 
 It is muscular in structure, is generally considered 
 to be about the size of the closed fist of its owner, is 
 
 Fig, 25. — Posterior Surface op the Heart. 
 
 c, c, the pulmonary veins ; Tc, h, the pulmonary artery ; /, the aorta ; 
 d, the superior vena cava ; n, the left auricle ; m, the right auricle ; r, the 
 inferior vena cava; o, the left ventricle ; I, the right ventricle ; h, the apex 
 of the heart. 
 
 divided by a vertical septum or partition into two 
 equal parts, and these are subdivided into four by a 
 partition passing horizontally. The four chambers 
 thus formed are called — the upper two, the auricles ; 
 the lower two, the ventricles. The base of the heart 
 is the broader or upper part, the apex the tapering. 
 
THE VASCITTiAR SYSTEM". 
 
 87 
 
 narrow portion, which strikes against the chest wall 
 between the fifth and sixth ribs, and about two 
 inches to the left of the breast bone. 
 
 The four chambers of the heart are equal in size 
 to one another, but differ greatly in the strength 
 and thickness of their walls, those of the ventricles 
 being much stronger than those of the auricles, and 
 the left ventricle being thicker and stronger than 
 the right The necessity for this will be seen when 
 
 Fig. 26.— View op the Heart avith the Eight Ventricle, opened 
 
 TO SHOW THE SEMILUNAR YaLVES. 
 
 a, Te, tlie pulmonary artery. 
 
 we come to speak of the circulation of the blood, and 
 the admirable fitness with which the means are 
 adapted to the end will be understood. The walls 
 of the heart are made uj) of muscular fibres, having 
 the same striped appearance as the muscles under 
 the influence of the will, but difi'ering from them in 
 this that they have no sheath. The heart is enclosed 
 in a kind of double membranous bag, called the 
 
38 THE VASCULAR SYSTEM. 
 
 'pericardium, whicli consists of an outer fibrons and 
 an inner serous portion. This latter layer invests its 
 outer surface and also lines the fibrous layer. They 
 become continuous with one another upon the aorta 
 and other great vessels of the heart. The openings 
 between the auricles and the ventricles, and the 
 ventricles and the arteries, are separated by valves, 
 the action of which we shall consider presently. 
 
 The arteries of the "body spring from the great 
 blood-vessel called the aorta, which aris3s from the 
 left ventricle of the heart. As they pass onwards to 
 the different parts of the body they divide and sub- 
 divide until they end in a delicate meshwork of 
 minute vessels, called capillaries, which, with the 
 exception of the epidermis, nails, and one or two 
 other portions, go to every part of the body, and are 
 so thickly clustered together that the prick of a 
 needle over the greater part of the surface is followed 
 by the oozing out of a drop of blood. These capil- 
 laries pass into another set of vessels, called veins, 
 which unite together to form two large trunks going 
 to the right side of the heart. 
 
 The arteries are hollow tubes, so elastic in their 
 structure that when taken out of the body they can 
 be stretched like a piece of indiarubber. They 
 consist of three coats — an outer, fibrous ; a middle, 
 muscular ; . and an inner consisting of a delicate 
 membrane with epithelial plates, and forming an 
 exceedingly smooth and polished surface for the blood 
 to flow over. The muscular coat is under the in- 
 
TUE VASCULAR SYSTEM. 
 
 30 
 
 Fig. 27.— Vjett of the Heaet with the Circulatory ApparAtvs. 
 vpnn' .nit ^T^ li "' ^^^ P?^"ionary artery; 3, Ihe inferior or ascendiog 
 lit^^ZLh- - ^"P^/^^'^«J descending vena cava; 5, the aortal 
 b, it» point of division ; 7, point of division of left common iliac artery 
 
40 THE VASCULAR SYSTEM. 
 
 fluence of tlie nervous system, and the effect of 
 emotion acting tlirougli the nerves upon the capil- 
 laries is seen when a person turns pale with fear 
 from the contraction of the capillaries; or, as in 
 blushing, when the capillaries become dilated. 
 
 Blushing may "be artificially produced in the ear 
 of the rabbit by division of the sympathetic nerve, 
 by which the inhibitory action, as it is called, or 
 that action, in other words, which controls and 
 regulates the dimensions of these vessels is lost. If 
 the arteries were rigid tubes, the blood, instead of 
 spurting out of them in jerks, as it does when one of 
 them is divided, would flow in a continuous stream. 
 This saltatory action, which results from the con- 
 tractions of the left ventricle and the propagation of 
 a wave motion through the arteries, which is known 
 as the pulse, and which may be felt in the radial 
 artery a little above the outer wrist, or in the 
 temporal artery of the head, enables the observer 
 to distinguish between bleeding from an artery and 
 that from a vein. 
 
 Injury to an artery is generally followed by much 
 more serious consequences than injury to a vein, 
 and so we find, with that admirable fitness that one 
 always sees in nature, that they are both more deeply 
 placed and better protected than the veins. 
 
 8, external; 9, internal iliac arteries; 10, left common carotid, with 
 internal jugular vein lying to its outer side ; 11, left subclavian artery and 
 its continuation, til e axillary; 12, the brachial; 13, the radial; 14, the 
 anterior tibial arteries ; 15, long saphenous vein ; 16, cephalic vein of 
 right arm ; 17, basilic vein ; 18, ramifications of pulmonary vein and 
 arteries in the left lung. The direction of the blood current is indicated 
 by the arrows. The veins are darker than the arteries. 
 
THF VASCULAR SYSTEM. 41 
 
 The veins are distinguished from the arteries by 
 
 being less muscular and less elastic in their structure, 
 
 and also by having valves connected with many of 
 
 them. If the arm be held in a dependent position, 
 
 especially when the body is warm, bluish lines will 
 
 be seen stretching along its surface. These lines 
 
 are veins, and if a handkerchief be tied round, say 
 
 the upper arm, the veins below will become swollen 
 
 and turgid, and, if the finger be run over them in a 
 
 direction away from the heart, a series of small 
 
 swellings will be felt. These swellings mark the 
 
 position of the valves, and result from the backward 
 
 pressure of the blood by the finger, bringing them 
 
 into play. The concave surface of the valves is 
 
 placed towards the heart, so that as long as the 
 
 blood continues to flow in the direction of that organ 
 
 no resistance is offered to it, but immediately there 
 
 is any obstruction in the way the action of the 
 
 valves is necessitated, and the little swelling referred 
 
 to above becomes apparent. 
 
 The blood flowing from an artery is further dis- 
 tinguished from venous blood by its colour, it being 
 of a bright scarlet, while that coming from a vein is 
 dark purple. In order to understand this difference 
 in the colour of the blood, as it appears in an arteiy 
 and in a vein, we must enter into the subject of its 
 circulation. 
 
42 THE CIRCULATION OP THE BLOOD, 
 
 THE CIRCULATION OF THE BLOOD. 
 
 When the left ventricle of tlie heart contracts 
 the blood is driven along the aorta and through the 
 arteries, which become less and less in size, till it 
 enters the capillaries ; from these it passes into the 
 veins, and is returned to the right auricle of the 
 heart by two large trunks, and by the contraction of 
 the auricle it is sent into the right ventricle, from 
 which it is propelled along the iDulmonary artery to 
 the lungs. Here the blood is exposed in minute 
 vessels, forming an exceedingly delicate network 
 upon the surface of the air cells, to the action of 
 the air entering by the wind-pipe into the lungs, by 
 which it becomes oxygenated and returns by means 
 of the four pulmonary veins to the left auricle of the 
 heart, from which it is drawn into the left ventricle. 
 
 In the progress of its course through the body 
 arterial blood gives off oxygen to the tissues and 
 receives carbonic acid, which converts it from arterial 
 into venous blood, and until it comes to the lungs 
 to receive a fresh supply of oxygen, it is unfit to 
 nourish the body. The oxygen that is carried to the 
 tissues is borne to them by the red cells of the blood, 
 of which there are many millions in the body, and 
 although the blood appears to be homogeneous, it, in 
 reality, consists of a watery fluid called serum, and 
 
THE CIRCULATION OP THE BLOOD* 43 
 
 the red cells already mentioned. These cells of the 
 
 Fig. 28.— YiEW of the Circulatio.x taken froii Before. 
 
 a, the right auricle ; h, the right ventricle ; c, the pulmonary artery ; 
 d, the lungs ; e, the pulmonary vein ; /, the left auricle ; g, the left 
 ventricle ; h, the aorta ; i, vessels supplying upper part of body with 
 blood ; /, m, vessels carrying blood to lower parts ; n, arteries of supply 
 for stomach, intestines, spleen, and panci'eas ; o, the abdominal viscera 
 just mentioned ; p, the vena portae ; q, the hver ; r, the hepatic vein j 
 s, the inferior- ; fe, the superior vena cava ; t, the terminal radicles. 
 
44 
 
 THE CIRCULATION OF THE BLOOD. 
 
 blood differ in appearance in certain animals, and, 
 by examination under the microscope, one wlio is 
 
 Fig. 29. — Front View of the Heart and Lungs. 
 
 a, the crico-thyroid muscle ; j,j, riglit and left coram on carotid arteries ; 
 6, the windpipe ; C, the right, and c, the left, innominate vein ; d, right 
 internal jugular vein ; e, the subclavian vein ; g, the arch of the aorta ; 
 h, the innominate artery ; i, i', right and left subclavian arteries ; 
 s, superior lobe of right lung ; t, the middle ; u, the inferior lobe j 
 y, interlobular fissure on right lung ; y, same on left lung ; %v, the fissure 
 which causes a partial division of the superior lobe of the right lung to 
 form the middle lobe ; 'p, p', the mediastinum ; r, r, the root of the lungs j 
 X X, convex surface of the diaphragm ; g, the pericardium. 
 
 skilled may be able to say from what animal tbe 
 specimen of blood given him to examine has 
 come. 
 
THE CIRCULATION OP THE BLOOD. 45 
 
 The blood possesses the remarkable property of 
 coagulating on exposure to the air. Wliile in the 
 body it remains fluid, but when exposed to the 
 atmosphere it begins to clot. This property of the 
 blood is remarkably useful, and frequently checks 
 bleeding from a wounded vessel. If it were not for 
 this any wound might prove fatal by simply allowing 
 the person to bleed to death. 
 
46 THE LUNGS AND BESPIEATION. 
 
 THE LUNGS AND EESPIEATIOK 
 
 As the heart is the great force-pump wliich drives 
 tlie blood through the different parts of the bodj, so 
 the lungs constitute another great pumping machine, 
 by which the impure blood that has done service in 
 the various tissues of the body, is exposed to the 
 influence of the air, has its hurtful qualities removed, 
 and its life-giving qualities restored, so that return- 
 ing to the left side of the heart it may be again pro- 
 pelled through its wonderful arterial net- work, the 
 bearer of life to every part of the body. In order to 
 understand the way in which this change is brought 
 about we must consider the structure of the lungs 
 themselves, and perhaps the simplest way to do so 
 will be to follow the trachea, or windpipe, in its 
 passage down the neck to where it divides into 
 the right and left bronchus. Following one of these 
 bronchi, we shall find that it passes into the lung 
 and there divides and subdivides in an infinity of 
 tubes, becoming gradually less and less in their 
 dimensions, until at last it ends in, or to speak more 
 correctly, expands into, the air-cells, or vescicles, of 
 the lung. So, then, the lungs consist of two highly 
 elastic bags composed of multitudes of little cham- 
 bers filled with air. 
 
 If the hand is passed along the neck of an adult 
 the cartilaginous bands which pass across the front 
 
THE LUNGS AND RESPIRATION. 
 
 47 
 
 of the windpipe may easily be felt, but as the bronchi 
 ramify in the lungs the cartilages entering into 
 their structure becomes less and less noticeable, 
 until at last it is lost altogether, so that in the ulti- 
 
 FiG. 30.— Th3 Thoracic Yiscera, looked at from Behixd. 
 
 a, the arytenoideua ; h, the trachea ; p, the bronchi ; g, the crico- 
 arytenoideus porticus muscle ; 7c, h', the pulmonary arteries ; I, m, the 
 pulmonary veins ; /, the arch of the aorta divided ; o, posterior surface of 
 heart; d, internal jugular vein; e, the subclavian; c, the innominate 
 vein ; h, the innominate artery ; j, right common carotid artery ; j', left 
 common carotid artery ; i, i', right and left subcla\dan arteries ; s, superior 
 lobes of the lung ; v, right interlobular fissure ; v, left ditto j x, base of 
 lung. 
 
 mate divisions— the air-cells of the lungs — there is 
 only a delicate membrane interposed on either side 
 between the capillary network in which the blood 
 is contained and the outer air, so that changes 
 between the outer air and the blood, and the blood 
 
48 
 
 THE liUNGS AND RESPIRATION. 
 
 and the air, may readily take place. It will be 
 remembered that the blood sent by the right ventricle 
 of the heart through the pulmonary artery to the 
 lungs was dark purple in colour, and it was pointed 
 out that this was due to the loss of oxygen and the 
 accumulation of carbonic acid which had taken place 
 in its journey through the body. In order that it 
 may be again fit for nourishing the body it must 
 
 Fig. 31. — Group ot" Lobules feom the Lung, showing the Air Cells, 
 OR Alveoli, into -which each small Bronchial Tube 
 
 ULTIMATELY DIVIDES. 
 
 part with its carbonic acid and obtain a fresh supply 
 of oxygen, and this is what happens in the lungs. 
 The capillary network of blood-vessels that surrounds 
 the air-cells of the lung is so fine, that a large 
 amount of blood can be exposed in a short time to 
 the influence of the air. If the air that is expired 
 or breathed out from the lungs be examined it will 
 be found to differ from that which is inspired, or 
 
THE LUNGS AND RESPIltATION. 
 
 49 
 
 dra-Nvn in, in the following respects. It is warmer, 
 moister, and contains a considerable amount of car- 
 bonic acid. The presence of carbonic acid in the 
 breathed-out air may be demonstrated by breathing 
 through a tube into a wine glass, or bottle, contain- 
 ing lime-water, when, from being colourless, it will 
 be found to become milky in aj^pearance from the 
 
 Fig. 32.— The Capillary Network of the PuLiiONAEY Blood 
 Vessels in the Luxgs. 
 
 union of the carbonic acid in the expired air with 
 the lime of the lime-water to form carbonate of 
 lime. 
 
 In order to nnder stand the mechanism of respira- 
 tion, and be able to form an intelligent idea of the 
 manner in which these changes are brought about, 
 we must remember that the lungs are contained In 
 the cavity of the thorax, which is bounded on its 
 
50 THE LUNGS AND RESPIRATION". 
 
 two sides by the ribs, in front by the breast bone, or 
 sternum, behind by the spine, and that it has for its 
 floor, or base, the diaphragm or midriff, and for its 
 apex the neck. But the lungs are not in direct con- 
 tact with the ribs. They are surrounded by, or 
 enveloped in, a delicate serous membrane called the 
 pleura, which consists of two layers, one of which 
 lines the inner surface of the ribs, and the other the 
 outer surface of the lungs. 
 
 The lungs, then, are exposed to the influence of 
 the outer air by means of the windpipe opening into 
 the larynx and through the glottis with the mouth. 
 They have pressure exerted upon them from within 
 equal to the ordinary pressure exerted by the 
 atmosphere, that is, fifteen pounds to every square 
 inch of surface, so that if the thorax, or box in which 
 the lungs are contained, be capable of altering its 
 size from less to greater, the outer air will at once be 
 ready to rush in and fill up the increased space, and 
 this is what actually happens during inspiration. 
 
 When the diaphragm contracts its surface becomes 
 flattened and the capacity of the chest is thus 
 increased in size. At the same time the outer 
 intercostal muscles, or little muscles, that pass from 
 above downwards and outwards, between one rib and 
 another, contract and raise the walls of the chest, 
 and air rushes in to fill the space thus formed, this 
 is the act of inspiration. But immediately after- 
 wards the diaphragm relaxes, the cavity of the thorax 
 
THE LUNGS AND RESPIRATION. 
 
 51 
 
 is diminished in size, and the inner intercostal 
 muscles, which run in an opposite direction from the 
 outer, contract and pull the ribs down again, expell- 
 ing the air from the lungs and giving rise to what is 
 known as expu-ation. 
 
 Fig. 33.— Feont Yiew of the Yisceka of the Thorax and Abdomen-. 
 
 p, p, the lungs ; m, the mediastinum ; h, that portion of the heart not 
 overlapped by the lung ;_ a, t, d, the ascending, transverse, and descending 
 portions of the colon ; i, the various coils of the small intestine ; n, the 
 npper part of the bladder ; I, I, the liver ; s, the stomach ; h, the spleen ; 
 g, the lower portion of the gall-bladder, projecting from under the liver. 
 
 Day and night, as in the blood-pumping action of 
 the heart, the air-pumping action in the chest goes 
 on, and if, by any means, the air is prevented from 
 getting access to the blood circulating in the lungs. 
 
52 THE LUNGS AND RESPIRATION, 
 
 or, what comes to the same thing, if the blood circu- 
 lating in the lungs is prevented from getting access 
 to the air — as, for example, in croup — the patient will 
 soon die. 
 
 In cases of drowning and strangulation, access of 
 air to the lungs being cut off, death speedily takes 
 place, and, on examination of a person who has died 
 in this way, it will be found that the lungs and right 
 side of the heart are filled with dark venous blood, 
 while the left side of the heart and the arteries are 
 nearly empty. 
 
 Whenever the supply of oxygen is cut off, or con- 
 siderably reduced in amount, as happens in small 
 rooms that are closely crowded, we are warned of 
 the danger we are incurring in remaining in such an 
 atmosphere by the feeling of languor and headache 
 which steals upon us, and we should endeavour to 
 get out of it as speedily as possible. 
 
 The lungs differ in colour at different periods of 
 life. In the infant they are of a rosy hue, but, as life 
 advances, from the absorption of particles of dust 
 and dirt, they become darker, and in some people, 
 whose occupations expose them to the inhaling of 
 large quantities of sooty material, they become 
 almost black. Some occupations act most injuri- 
 ously upon the fine texture of the lungs, and, as in 
 needle-grinders and stonemasons, destroy their 
 breathing power and shorten life. 
 
THE SKIN AND ITS APPENDAGES. 53 
 
 THE SKIN AND ITS APPENDAGES. 
 
 In speaking of respiration, it was noticed that the 
 air issuing from the lungs contained more watery- 
 vapour than that which entered them, so that from 
 the lungs a certain quantity of watery vapour was 
 given off into the surrounding atmosphere ; but we 
 come now to speak of an organ, the skin, through 
 which a much larger quantity of moisture passes 
 into the air than from the lungs. Sometimes this 
 watery vapour passes away in the form of sensible 
 perspiration or sweat, visible to the naked eye, but 
 by far the largest amount passes away in the form of 
 insensible perspiration, which takes place at all hours 
 of the day and night, and in twenty-four hours the 
 body loses in this way nearly two pints of fluid. Eor 
 the purpose of secreting so large an amount of 
 liquid, sweat-glands are provided all over the body, 
 and so numerous are they that, in those parts of the 
 body where perspiration takes place most abundantly, 
 they are so close together as to amount to between 
 2,000 and 3,000 to the square inch, so that some 
 idea may be formed of the important functions 
 which the skin exercises in the maintenance of 
 health. 
 
 In warm weather, or under violent exercise, the 
 amount of water excreted by the skin may be 
 very greatly increased, and in some diseases, where 
 
^4 THE BKIN AND ITS APPENDAGES. 
 
 the temperature of tlie body is raised, tlie physician 
 tries to reduce it by giving remedies which cause the 
 skin to act more freely. To a certain extent the 
 kidneys may assist the skin when the function of the 
 latter is impaired, just as the skin relieves the kid- 
 neys when they are diseased. But any very serious 
 chock or loss of the function of either, as, for ex- 
 
 FiG. 34.— The Skin of the Negro. 
 
 ample, when the body of a dog is varnished over, 
 or the kidneys are removed, is followed by death. 
 When the skin is acting freely, any sudden expo- 
 sure to cold, followed by a chill, is succeeded by an 
 inward rush of blood from the surface of the skin 
 to the deeper lying organs of the body, and, unless 
 speedily removed by warm baths, extra clothing, 
 
THE SKIN AND ITS APPENDAGES. 
 
 55 
 
 and the use of such remedies as will cause the skin to 
 act again freely, may set up congestion and inflam- 
 
 mation of these organs. 
 
 The sHn is divided into two portions, an upper or 
 outer, the epidermis, cuticle, or scarf-skin, and a 
 lower or under, the corium, derma, or true skin. 
 The cuticle consists of epithelial cells, flattened on 
 
 Fig. 35.— Vektical Section through the Skin. 
 
 a, the homy; b, the mucous layer of the epidermis ; c, its deeper layer, 
 the rete Malpighii ; d, the papillae ; e, the true skin ; /, fat cells ; gr, sweat 
 glands ; li, sweat ducts, opening at i, i, on the surface of the skin. 
 
 the outer surface, and more rounded in the lower 
 layers, differing in thickness in different parts of the 
 body, and consisting, in some places where the skin 
 is exposed to pressure, as in the soles of the feet and 
 the palms of the hands, of many layers. The flat- 
 tened cells on the top are just the more rounded, 
 deeper ones worn by use and ready to be shed. It 
 
56 TBE SKIN AND ITS APPENDAGES. 
 
 is this part of the skin which is raised when a blister 
 is applied to any part of the body, or when a person 
 is suffering from the chicken-pox, eczema, or shin- 
 gles. Injury to this part of* the skin leaves no mark 
 or scar behind it. 
 
 The true skin consists of a delicate interlacement 
 of connective-tissue fibres, which are woven together 
 till they resemble a substance like felt. In its lower 
 part the meshes are more open and cellular tissue 
 elements accumulate, forming fat, which gives a 
 rounded contour to the body. It varies in amount 
 in different individuals. It is here also that water 
 accumulates in cases of dropsy. The upper part of 
 the true skin is thrown into a number of elevations 
 called papillse. In many of these, small blood- 
 vessels enter, forming capillary plexuses, which join 
 together, forming veins ; by these the blood, after 
 circulating in the papillae, is carried away. There 
 are other papillse containing nerves, but no blood- 
 vessels. These form the tactile corpuscles, or touch 
 bodies, which are most numerously developed where 
 the sense of touch is most acute, as in the palms of 
 the hands and soles of the feet. 
 
 In addition to these the skin is abundantly sup- 
 plied with nerves, giving to it an exquisite degree of 
 sensitiveness, and enabling it readily to give warning 
 of the presence of danger. 
 
 lu addition to the sweat-glands already noticed, 
 there are other glands forming little grape -like 
 
THE SKIN AND ITS APPENDAGES. 
 
 57 
 
 clusters in the true skin, and opening by means of 
 little tubes into the liair follicles. These are the 
 sebaceous glands. They secrete an oily substance, 
 which has for its object the lubricating of the surface 
 of the skin, and so protecting it from injury. In 
 warm countries the natives supplement the action of 
 these glands by oiling the surface of the body, and so 
 
 Fig. 36.— Section op Skin from the Head, showing the Roots of 
 THE Hair and the Sebaceous Follicles. 
 
 d, homy layer of cuticle; e, mticous layer; a, sudoriferous glands; 
 7i, the sweat ducts proceeding from these to open on the surface of the 
 ekin ; /, adipose cellular tissue ; h, a hair having its projection above the 
 ekin ; c, the hair follicle. 
 
 protecting it from the hurtful effects of the sun's 
 ra)^. 
 
 When the action of the glands is defective the 
 skin becomes hard and dry. Sometimes they become 
 blocked up and inflamed, and the disagreeable dis- 
 ease, known as acne, results. In order to keep the 
 skin healthy, and a large and important secreting 
 
58 
 
 THE SKIN AND ITS APPENDAGES. 
 
 surface performing? its functions aright, frequent 
 wasliing and friction are necessary. 
 
 The lower surface of the epidermis, or cuticle, 
 tliat part, namely, lying immediately above the 
 
 Fig. 37.— Vertical Section of the Skin of a Negro. 
 
 a, the cutis, or true skin ; h', the pigment, or colouring matter j b, the 
 epidermis, or cuticle. 
 
 papillae, is the part in which pigmentary deposits 
 take place, as in the negro, and in people who suffer 
 from freckles. 
 
 Fig. 38. — Section of the Skin, showing a Hair. 
 
 O, the root ; h, the stem ; c, the sheath ; d, mucous layer of cuticle j 
 
 /, horny layer. 
 
 Hairs and nails are appendages of the skin. The 
 former consists of a root, a stem, and a point, which 
 opens upon the surface of the body : the latter of a 
 
THE SKIN AND ITS APPENDAGES. 
 
 59^^ 
 
 root embedded in a part of the true skin, and from 
 which it, in reality, originates, called the matrix, a 
 body and a free edge. In connection with the hair 
 are small muscles, which, under the influence of cold, 
 fear, and various other emotions, contract, giving 
 rise to what is known as goose-skin. 
 
 Fig. 39.— Vertical Section op the Ungual Portion oi? a Fingee, 
 
 TO SHOW THE APPEARANCE OF THE NaIL. 
 
 a, the fold of epidermis at the base of the nail ; d, the epidermis, 
 showing its continuity with the deepest layer of the horny lamina; &,_th9 
 body of the nail ; c, the duplicature of the skin, into which the nail is 
 received j c', the thick dermis, separating the nail from the phalanx. 
 
 In the lower animals the muscles of the skin are 
 much more powerfully developed, and enable them, 
 as seen in cats, to make the hairs stand up on end, 
 and dogs and horses to shake themselves. 
 
60 SOUECES OP GAIN AND LOSS. 
 
 SOUECES OF GAlJSr AND LOSS. 
 
 In speaking of tlie skin and tlie lungs it was 
 pointed out that a great loss occurred to the body in 
 the passing away of a large quantity of fluid in the 
 form of perspiration, and, during expiration, as 
 watery vapour from the lungs, and carbonic acid, the 
 result of decomposition, going on in the bod}^. The 
 contraction of every muscle, the exercise of every 
 faculty of the mind, is accompanied by the expen- 
 diture of so much of the vital element, constant 
 molecular death accompanying the manifestations 
 of life, and the waste products are removed by the 
 kidneys and the organs already mentioned. 
 
 In order to supply the loss thus constantly going 
 on in the body, fresh supplies must be taken into the 
 system to serve as fuel, enabling combustion to take 
 place and the vital processes to be carried on. This 
 fuel is supplied to the body in the form of food, and 
 an adequate amount is necessary to enable the body 
 to perform its functions aright. If the quantity of 
 food taken into the system is too small for the proper 
 working of the machine, starvation will take place, 
 and reduction of the weight of the body will ensue, 
 and when this has reached a certain limit death will 
 result. If, on the other hand, the amount of food 
 taken into the system be greater than its require- 
 
SOTTBCES OP GAIN AND LOSS. 
 
 61 
 
 ments, the harmonious working of the various parts 
 will be disturbed and disease engendered. 
 
 Mau seems to occupy a position, as regards his 
 digestive apparatus, midway between the carnivo- 
 rous or flesh-eating animals, and the herbivorous, 
 although vegetarians may dispute this, and, in con- 
 
 FiG. 40. — Vertical Section through the Head from Before Back, 
 
 SHOWING THE CAVITIES OF THE MoUTH AND NoSE. 
 
 a, the arch of the palate ; &, the tongue ; c, the velum palati ; 
 d, the lips ; e, the teeth ; p, prominence corresponding to anterior margin 
 of internal pterygoid muscle, behind /, anterior pillar of the fauces ; 
 g, posterior pillar ; n, the tonsil ; i, the epiglottis ; u, the uvula ; 1, posterior 
 opening of nares ; 4, opening of the Eustachian tube ; the isthmus of 
 the fauces ; 3, is placed opposite superior opening of larynx ; 1, the nasal ; 
 2, guttural ; 3, laryngeal portion of larynx ; y, oesophagus ; v, larynx ; 
 sc, trachea ; t, thyroid cartilage. 
 
 sequence, it is believed that the best form of diet is 
 that which is of a mixed character. When an indi- 
 dividual is fed long upon one article of diet a terrible 
 loathing is apt to result, and, rather than continue 
 it, starvation will appear preferable. When food is 
 
62 SOTTKCES OF oAirr AND LOSS. 
 
 taken into the mouth, it undergoes the process of 
 mastication, or, perhaps, it might be more correct to 
 say, it ought to undergo this process, because some 
 people, who have got into the habit of bolting their 
 food, hardly masticate it at all, and yet mastication 
 is an important process, it assists digestion to a con- 
 siderable extent, and some articles of diet of a starchy 
 nature, such as potato, are very difficult of digestion, 
 
 Fig. 41. — Abdominal Portion or Alimentary Canal. 
 
 s, fhe stomacli ; a, lower part of oesophagus, or gullet ; h, duodenum ; 
 c, termination of duodenum and commencement of coils of small intestine 
 extending to d, where the ilium, or third portion, ends in the caput ccBcum, 
 in which the large intestine begins ; v, vermiform process ; e—f, ascending ; 
 f—g, transverse ; g — h, descending portion of colon ; h — i, rectum. 
 
 unless they have been well masticated. The reason 
 of this is, that in the mouth, while food is being 
 chewed, saliva is poured out from the different 
 glands which open into the mouth, and this sub- 
 stance has the remarkable property of converting 
 starch into sugar, and so materially assisting in its 
 digestion. 
 
SOURCES OF GAIN AND LOSS. 
 
 63 
 
 When the food is suf5.ciently masticated it is 
 passed along the tongue and swallowed — that is to 
 say, it passes from the mouth into the pharynx, and 
 thence into the oesophagus, or gullet, along which it 
 is propelled till it reaches the stomach. 
 
 In man the stomach is a hollow muscular bag. 
 
 
 Fig. 42. — Vertical Transverse Section op the Coats of thb 
 
 Stomach. 
 
 I, gastric glands ; m, muscular layer of the mucous membrane ; b, sub- 
 mucous, or areolar coat ; g"*, circular muscular layer ; l"*, longitudinal 
 muscular layer, and serous coat. 
 
 consisting of one compartment only, being, in fact, 
 nothing more than a dilatation of the intestinal canal. 
 When tbe food reaches the stomach, owing to the 
 contraction of its muscular fibres, it is moved about, 
 up and down, within it, and while this movement is 
 going on the glands of the stomach, situated in the 
 
64 SOURCES OP GAIN AND LOSS. 
 
 mucous membrane (see diag.), pour out a fluid, 
 the gastric juice, which, is the principal faotor in 
 digestion. 
 
 After about two hours, the contents of the stomach, 
 so treated, have the appearance of buttermilk, and 
 this substance, which is now called chyme, passes 
 into the first part of the small intestine. Here two 
 other fluids are brought to bear upon it, the one 
 coming from the liver, and called the bile, uhe other 
 from the pancreas, or sweetbread, and called the 
 pancreatic juice. 
 
 The result of the action of these two fluids is, 
 that the process of digestion is carried to a further 
 extent, and the chyme becomes converted into a 
 milky fluid called chyle. This chyle is now taken 
 up by the small absorbent vessels of the intestine, 
 and carried away by means of little tubes to the 
 thoracic duct, which passes up along the front of the 
 spine to the root of the neck, where it opens into one 
 of the great veins, the left internal jugular. It is then 
 conveyed to the right side of the heart, from which 
 it passes into the lungs, where it is acted upon by the 
 oxygen of the air, and becomes the source of nutri- 
 ment for all the various tissues of the body. 
 
THE GLANDS OF TUE BODY, 
 
 65 
 
 THE GLANDS OF THE BODY. 
 
 Fig. 43.— The Abdomixal Yisceka, with the Liver turned up 
 
 TO SHOW THE DUODEXUM. 
 
 a, the cesophagus or pallet ; b, c, the stomach ; d, its cardiac ; /, ita 
 pyloric end; e the left cul-de-sac ; S', descending portion of duodenum; 
 j,right lobe of hver;^, left lobe; X-, gall bladder; Z, the common bile 
 duct ; m, m, coils of the small intestme ; o, the CEecum ; s, the appendix 
 vermiformis; n, the ilep-csecal valve; q, the ascending colon; r, s,t, the 
 blSdef^^ '^' ^' sigmoid flexure of colon; v, the rectum; withe 
 
 E 
 
QG THE GLANDS OF THE BODY. 
 
 These diiFer in size, shape, and structure from 
 one another, but resemble eacb other in this, 
 that all possess the power of abstracting from or 
 manufacturing out of the blood circulating in it, its 
 own peculiar secretion. 
 
 Of these glands the largest is the liver, which 
 is situated at the upper part of the abdominal cavity 
 on the right side. It is a most important organ in 
 the animal economy, being present in all vertebrate 
 and in many invertebrate animals. Indeed, so 
 necessary is it that it is only very low down in the 
 scale of the animal kingdom that it is absent. It is 
 of a dull reddish colour, the upper surface being 
 smooth and rounded, and corresponding with the 
 cavity of the diaphragm. The under surface is 
 concave and uneven. It is maintained in position 
 by means of ligaments which are prolongations of 
 the peritoneum with which its surface is covered. 
 It is divided into several lobes, the right and left 
 being the largest. The former is much thicker and 
 larger than the latter. It possesses the power of 
 secreting bile, which passes into the intestine to 
 assist in the process of digestion. It also elaborates 
 from the blood passing through it a substance of a 
 starchy nature called glycogen, which, however, 
 it readily converts into grape sugar, in which 
 form it is served out in varying quantities 
 from time to time. It is also looked upon as 
 one of the sources of the colourless corpuscles of 
 the blood. 
 
THE GLANDS OF THE BODY, 
 
 07 
 
 Fig. 44. — The Pancreas and surrounding Organs. 
 The liver and stomach, are turned upwards to show the duodenum, the 
 pancreas, and the spleen, a, the aorta ; h, the third or transverse portion 
 of the duodenum; c, the cardiac ead of the stomach; d, the crura or 
 pillars of the diaphragm ; e, e', the descending portion of the duodenum ; 
 p, the pyloric end of the stomach ; I, the left lobe of the liver ; I', the 
 right lobe of the liver ; g, the gall bladder ; x, the hepatic duct ; 
 s, the under surface of the stomach ; o, the pancreas ; I', the spleen ; 
 t, commencement of the jejunum, or second portion of small intestine ; 
 m, the superior mesenteric artery ; t, the co^liac axis. 
 
 The pancreas or sweetbread is a long dog's- 
 tongue shaped gland, which passes transversely 
 across behind the stomach. As already mentioned, 
 it secretes the pancreatic juice, which is carried away 
 by a duct to the upper part of the small intestine to 
 assist in the transformation of chyme into chyle. 
 
 The spleen is a dark red spongy body of friable tex- 
 ture, situated on the left side of the body at the upper 
 part of the abdominal cavity in contact with the tail 
 of the pancreas. It seems to be concerned in the 
 manufacture of the wdiite cells of the blood ; and in 
 some diseases, as in ague, it becomes greatly en- 
 larged. 
 
68 
 
 THE GLANDS OF THE BODY. 
 
 Two other glands are the kidneys. They are 
 bean-shaped bodies situated on either side of the 
 spinal column in the loins. They are surrounded 
 by a fibrous coat, which forms a thin, smooth, 
 closely-fitting covering for each, and consist of 
 two parts, an inner or medullary, and an outer 
 or cortical portion. Their special function is the 
 separation of water and urea from the blood. This 
 secretion is carried by a tube from either kidney to 
 the bladder. 
 
 Fig. 45. 
 Vertical Section of a Kidney. 
 
 Fig. 4G. 
 Vertical Section oe a Kidnet. 
 
 Fig. 45.— a, cortical portion; h, bases of the pyramids; d, apices; 
 c, divisions of the pelvis of the kidney, called calyces, into which the 
 pyramids open ; c, a calyx of the kidney unopened ; e, the papillae formed 
 by the apices of the pyramids projecting into the calyces ; h, the hilus, 
 or fissure, in the kidney ; p, the pelvis, or enlargement of the ureter 
 within the sinus ; u, the ureter. 
 
 Fig. 46.— a, the external or cortical substance ; h, the broad part of the 
 pyramids ; c, their apices ; d, d, the calyces, or inf undibula ; e, the pelvis 
 of the kidney ; /, the ureter ; g, the renal artery ; h, the renal vein. 
 
DISEASES AND ACCIDENTS 
 FOR WHICH FIRST AID MAY BE REQUIRED 
 
 BRUISES. 
 When a person receives a blow on any part of 
 the body, the part struck remaining nnbroken, what 
 is called a bruise will result if the blow has been 
 inflicted with sufficient severity. The same thing 
 may happen when part of the body is crushed, the 
 deeper textures being injured, and the soft, yielding 
 skin remaining intact. When such a blow is in- 
 flicted, or part of the body crushed, pain is felt, and 
 swelling soon becomes apparent over the seat of 
 injury. The swelling is the result of an eff'usion of 
 blood into the cellular tissue caused by the rupture 
 of blood-vessels. It is succeeded after a time, varying 
 from a few hours to several days, by a discoloration 
 of the skin. This discoloration takes place most 
 rapidly when the blood poured out is near the sur- 
 face, and appears later when the efiusion takes place 
 among the deeper textures. 
 
 The discoloration resulting from a blow is not 
 at all times the same in appearance. At first it is 
 reddish blue, and passes through different shades 
 of colour till it has a greenish-yellow look, after 
 which it disappears. This discoloration is called 
 by surgeons ecchymosis, and results from the pig- 
 ment or colouring matter of the blood passing 
 through different changes. Some people are under 
 
70 BRUISES. 
 
 the impression that the blood thus thrown out can 
 be removed from the part by the application of 
 leeches. This, however, is a popular delusion, as it 
 is not the discoloured blood, but the fresh blood from 
 the capillaries which the leeches take away when 
 applied to a bruise. In some cases larger quantities 
 of blood are effused, and give rise to a swollen or 
 baggy feeling over the seat of injury. 
 
 Treatment op Bruises. 
 
 The best treatment for a "bruise is to apply some 
 evaporating lotion, such as spirit and water, tincture 
 of arnica, vinegar, or sal-ammoniac, which, when 
 applied to the surface of the body by means of rags 
 dipped in them, evaporate, and in so doing cause 
 absorption of the effused blood. 
 
 The following are useful combinations:— Chloride 
 of ammonium (sal-ammoniac), an ounce; rectified 
 spirit, whisky, lavender water, or eau-de-Cologne, 
 two ounces ; vinegar, three ounces ; water to make 
 sixteen ounces. Mindererus spirit or acetate liquor 
 of ammonia, two ounces ; rectified or one of the 
 other spirits, four ounces ; rose water to make sixteen 
 ounces* 
 
WOUNDS. 
 
 WOTJOT)S. 
 
 Wlien an injury results in the cutting through, 
 of the slvin, producing what surgeons call a solution 
 of continuity, a ivound is said to result. Wounds 
 are of different kinds, and differ in their severity 
 from the cut of a penknife to the gash of a sword- 
 thrust received in battle. The simplest form of 
 wound is that in which the tissues are clean cut 
 through, and where the edges, where brought together, 
 fit accurately the one to the other. Such a wound 
 is generally produced by a sharp-edged instrument, 
 as a knife or sword, although some saws, from 
 the rapidity with which they revolve and the fine- 
 ness of their teeth, give rise to so clean-cut a 
 wound that it would be difficult to distinguish from 
 one caused by a knife. 
 
 A wound of this nature generally heals by what 
 is called first intention — that is to say, the edges 
 being brought together accurately, and all bleeding 
 at an end, lymph is thrown out and the cut edges 
 become glued together. After a wound such as this 
 has healed, a cicatrix or scar is left behind, which is 
 at first red in colour, but afterwards becomes paler. 
 
 Treatment of Wounds. 
 
 In order to secure that a wound shall heal by 
 the first intention, care must be taken to remove 
 
72 , WOUNDS. 
 
 from it any foreign body sncli as dnst or dirt, which 
 would act as an irritant, then bring the edges care- 
 fully together by means of a bandage or strips of 
 plaster, and insure that the part shall be kept at 
 rest for two or three days. 
 
 In large wounds the surgeon finds it necessary 
 to bring the edges together and keep them in ap- 
 position by means of stitches either of silver wire, 
 silk, or catgut, but all that an unprofessional person 
 can do in such cases is to free the wound from all 
 impurities, sponging it with a little carbolic acid 
 and water of the strength of one part to forty, sanitas 
 and water, weak solution of Condy's fluid in water 
 (a teaspoonful to about eight or ten ounces of water), 
 or, if none of these be at hand, simple cold water ; 
 then bring the edges of the wound as near together 
 as possible, and keep them so by means of a bandage 
 or strips of plaster. 
 
 If the wound is not suiSciently severe to call in 
 medical assistance, after cleansing it in the manner 
 above described, a piece of lint soaked in carbolic oil 
 made with one part of carbolic acid to twenty parts 
 of olive oil, or spread over with boro-glyceride, or a 
 rag on which some boracic ointment has been spread, 
 may be used as a dressing, and a bandage applied 
 over it to keep the parts at rest. It is difficult in 
 some wounds, owing to their position, to keep the 
 edges close together : as, for example, in a wound 
 passing across the front of the thigh or transversely 
 
WOUNDS. 73 
 
 over the elbow joint. In these cases what one has 
 •to do is to relax the muscles, which by their action 
 cause gaping; this may be done by altering the 
 position of the limb. 
 
 A little manipulation of the part and the exercise 
 of common sense and the position best adapted to 
 union will soon be ascertained. Thus a pillow placed 
 under the leg, in the case of the thigh wound, and 
 extension of the arm in that of the elbow joint, will 
 accomplish what is desired. 
 
 Wounds, however, are not always so simple as 
 
 those just described, and do not invariably heal by 
 the first intention. In such cases, instead of a 
 pouring out and glueing of the edges together with 
 lymph, there occurs what is called suppuration. 
 Matter is formed, the wound granulates, or, as it is 
 popularly called, " proud flesh" forms in it, and then 
 it heals. 
 
 CONTTJSED OE LACERATED WoTJNDS. 
 
 These are wounds in which the edges, instead of 
 being clean cut, are ragged and uneven, and, to a 
 certain extent, have lost their vitality. It is impos- 
 sible, in wounds of this nature, to get the edges 
 togetber, or even if they could be brought together, 
 to bring about union by the first intention, because 
 the edores will die, and to a certain extent will slouorh. 
 away, granulations making their appearance, and 
 the wound healing as already described. 
 
74 WOUNDS. 
 
 Wounds of tliis sort are caused by blunt-pointed 
 instruments, bites, as from borses, kicks, &c. 
 
 Teeatment of Contused or Laceeated Wounds. 
 
 All tbat can be done in these cases, without 
 medical aid, is to cleanse the parts well with some 
 antiseptic lotion, place an antiseptic dressing over 
 it, and keep the edges as nearly together as possible 
 by means of a bandage. The same lotions and 
 dressings as were applicable in the case of simple 
 wounds will answer here. 
 
 There is sometimes a risk in these contused or 
 lacerated wounds of what is called secondary hsemorr- 
 hage, or bleeding, which does not occur at the 
 time of the accident, but at an indefinite period 
 after. To understand how this bleeding is brought 
 about, it must be remembered that the tissues have 
 lost their vitality to a certain extent, and that 
 injured blood-vessels, not bleeding at the time, may 
 give away afterwards, and cause a good deal of 
 trouble. This form of hsemorrhage is only likely to 
 take place if the wound is deep, or if it has occurred 
 in the region of important blood-vessels. 
 
 Peefoeating Wounds. 
 
 A perforating wound is one caused by a sharp- 
 pointed instrument of the nature of a dagger. It is 
 deceptive in its character, because of the slight 
 
WOUNDS. 75 
 
 appearance wliich it presents on tlie surface. It is 
 not the extent but the depth of a perforating wound, 
 and, of course, the part of the body in which it 
 occurs, which renders it dangerous. On looking at 
 such a wound, as it presents itself to the eye, one is 
 apt to regard it as trivial and unimportant, but, 
 although the skin-opening may be small, the fibres 
 of underlying muscles may be divided, and a cavity 
 exist out of all proportion to the size of the external 
 wound, and in this cavity discharges are retained, 
 and, owing to the small size of the surface opening, 
 are unable to get away, and may give rise to irrita- 
 tion, inflammation, and blood poisoning. 
 
 Treatment of Peepoeating Wounds, 
 
 A wound of this nature ought never to be treated 
 lightly. The part must be kept at rest, and ice- 
 bags, or pieces of ice, placed in a bladder, or cloths 
 soaked in cold water, to which some ant-iseptic has 
 been added, such as sanitas or carbolic acid, applied 
 to the wound. A bandage may then be applied, 
 unless the ice-b^g has been placed next the skin, to 
 keep the parts in apposition. 
 
 If there is bleeding the application of the ice-bag 
 may check it, or a small crystal of iron alum may 
 be placed in the mouth of the wound. This is all 
 that can very well be done by an unskilled person, 
 but if medical aid has not been sought at the time, 
 the patient must be carefully watched, and if the 
 
76 WOITNDS. 
 
 edges of the wound become red and angry-looking, 
 or if there is a red appearance of the skin ronnd 
 about it, and the patient's pulse becomes quick, the 
 skin hot, and he complains of thirst, no time should 
 be lost in sending for medical assistance. 
 
 If there is much pain after the injury has been 
 received an opiate may be given with advantage, 
 such as twenty or twenty-five drops of laudanum, 
 solution of the muriate of morphia or nepenthe. 
 The diet should be light, and stimulants had better 
 be avoided, unless to remove faintness at the time 
 the wound is received, or when ordered by the medical 
 attendant. 
 
 If a perforating wound has been received in an 
 important cavity, such as the abdomen, there may 
 be little external bleeding, and yet the pallor which 
 comes over the patient's countenance shows that he 
 is losing blood, and that inward bleeding is going on. 
 This, of course, is very serious, but all that anyone 
 can do till medical help arrives is to keep the patient 
 absolutely at rest, and apply ice, if it is to be had, 
 or cold water cloths, if it is not. 
 
 Perforating wounds of the chest may pierce the 
 lung, giving rise to cough and spitting of blood. 
 Here a bandage should be applied, moderately tightly, 
 round the chest, and the patient kept at rest. All 
 bleeding is made worse by movement, and fainting is 
 apt to be brought on when the patient is kept in an 
 upright posture, so that rest, with the head low, is 
 
WOITNDS. 77 
 
 favourable to the prevention of these tmtoward 
 symptoms. 
 
 Gunshot Wounds. 
 
 These have certain peculiarities of their own. Thus, 
 when a bullet from a gun or pistol enters one part of 
 the body and passes out at another, the appearance of 
 the two wounds caused is different, that by which the 
 ball entered being small, depressed, and if the shot has 
 gone off close to the body, the surrounding skin will 
 generally be blackened by the grains of gunpowder 
 that have entered it. The exit wound, or that by 
 which the ball has j)assed out of the body, will be 
 larger, and have the edges everted or turned out. 
 
 Sometimes the ball instead of passing out of the 
 body, lodges in some part of it, either deep down, 
 where it cannot be felt by the hand, or, more super- 
 ficially, under the skin, where it can be both readily 
 seen and felt. Yery curious indeed are the turnings 
 and twistings which a bullet will take in passing 
 from, one part of the body to another ; but it must 
 always be remembered, in reference to these wounds, 
 that all the textures through which the bullet has 
 passed, from its entrance into the body to its passing 
 out, or its lodgment in some other part, have lost 
 their vitality, and that the wound so caused is very 
 apt to be followed by suppuration, irritative fever, 
 and blood poisoning. There is not generally much 
 bleeding from wounds of this description at the 
 time of accident, but not unfrequently, owing to 
 
78 worNDS. 
 
 tlie parts tliat have been injured slougliing awaj, 
 lisemorrliage may take place afterwards. 
 
 Treatment of Gunshot Wounds. 
 
 In an accident of this kind all that can be done 
 may be best learned by knowing what would be done 
 by a surgeon under the circumstances. Usually 
 speaking, after receipt of an injury of this nature, 
 there is a good deal of anxiety and nervous depres- 
 sion for a variable time, and for which recourse may 
 be had to the administration of stimulants, such as 
 wine, a little brandy-and-water, or a teaspoonful of 
 the aromatic spirit of ammonia (spirit of sal- volatile). 
 
 If the ball has not passed out of the body, and is 
 within easy reach, the surgeon will remove it, either 
 by the wound through which it entered, or, if at a 
 considerable distance from that, by making another 
 opening over the place where it is lying, and extract- 
 ing it by means of a pair of forceps. 
 
 All foreign "bodies, such as pieces of clothing, wad- 
 ding, or bits of paper, should be carefully removed 
 from the wound whenever they can be laid hold of, 
 as, if left, they will set up irritation, and interfere 
 with the patient's chance of recovery. If the ball is 
 deeply seated, or uncertainty exists as to its where- 
 abouts, the surgeon usually leaves it alone, as more 
 harm would be done in hunting about for it than by 
 letting it remain quietly where it is. 
 
WOUNDS. 79 
 
 When the wound has been cleansed as far as pos- 
 sible of all foreign matters, it may be bathed or 
 gently syringed with sanitas and water, Condy's 
 fluid, carbolic acid, or other antise^Dtic, as before 
 indicated, after which a strip of lint, soaked in one 
 to twenty carbolic oil, or sanitas vaseline, may be 
 laid into the wound. This dressing may be changed 
 once or twice a day, and the wound bathed with 
 some antissjDtic lotion. 
 
 Where a number of lead pellets have entered, more 
 harm than good might result to the patient by any 
 effort to extract each individual one. So that, in 
 these cases, the surgeon generally prefers to allow 
 them to remain where they are, and wait to see if 
 any symptoms of mischief make their appearance 
 before he deems it necessary to interfere. 
 
 When bones have been struck by a bullet, or it has 
 
 entered a joint, the injury is of so severe a nature 
 that help should be sought at once, and all that can 
 be done till the arrival of the surgeon is to ward off 
 faintness in the manner already described, apply 
 some antiseptic to the part, and keep it as much at 
 rest as possible. 
 
 Poisoned Wounds. 
 
 These may result froYA a variety of causes, such 
 as pricks during dissection or in making post-mortem 
 examinations, stings of insects, such as mosquitoes, 
 snake bites, the bites of rabid animals and those 
 
80 WOUNDS. 
 
 which result from poisoned weapons^ such as arrows 
 and darts used in warfare. The effect produced 
 varies in degree. 
 
 In this country the stings of insects and the 
 poisoned wound caused bj the viper are generally 
 harmless in their effects. "Wounds received in the 
 dissecting-room are not generally followed by any 
 very serious consequences, and when constitutional 
 disturbance takes place it generally does so by causing 
 pain up the arm, with red lines running along the 
 course of the veins, and sometimes by swelling of 
 the glands in the armpit. When these effects result 
 from a wound of this nature the person is generally 
 in a feeble habit of body at the time, or there is 
 some constitutional peculiarity to account for them. 
 
 Wonnds received during the making of post- 
 mortem examinations are much more serious, and 
 are frequently followed by rigors, headache, thirst, 
 feverishness, and other symptoms of irritation. 
 Butchers, from working much among dead meat, 
 sometimes suffer from a malignant pustule. 
 
 Treatment of Poisoned Wounds. 
 
 When a wound is received in the dissecting-room 
 
 it should be at once sucked, and may then be touched 
 with some caustic, such as nitrate of silver. Some 
 aperient medicine may be given, and if there is 
 debility remaining, tonics, such as those containing 
 iron, ought to be administered. 
 
WOUNDS. 81 
 
 Post-mortem wounds, being mueli more serious 
 in their nature, should always be regarded gravely. 
 The patient ought to be put to bed, and a mild, 
 soothing lotion, such as acetate of lead and opium, 
 in the following proportions, applied tepid to the 
 part: Acetate or sugar of lead, sixty grains, lauda- 
 num, half an ounce, and water to make eight ounces. 
 If there is much depression a teaspoonful of aromatic 
 spirit of ammonia (spirit of sal- volatile), or the same 
 of brandy, may have to be administered every horn- 
 in a little water, and if the wound puts on an irritable 
 and inflamed appearance it had better be enlarged, 
 and warm cloths applied, so as to favour bleeding. 
 Of course medical assistance ought to be sought in 
 these cases. 
 
 The malignant pustule is to be destroyed by the 
 application of nitrate of silver, and then poultices of 
 linseed meal, or warm, soothing lotions, such as lead 
 and opium, or an infusion of poppy heads and 
 camomile flowers, applied to the part. 
 
 Stings of Insects and Bites feo:!i Yipees. 
 What best to do in stjch Cases. 
 
 In this country these accidents should be treated 
 as follows : — Suck the wound well, then apply some 
 alkaline lotion to the part, such as a little ammonia 
 water or liquor potassse and water, or bicarbonate of 
 soda and water. The juice of a raw onion is said to 
 be useful in relieving pain, and may be tried if the 
 
 F 
 
82 WOUNDS, 
 
 others fail, or if an onion can be more readily pro- 
 cured than the substances already mentioned. If any 
 faintness should result, give a teaspoonful of sal- 
 volatile, or a little brandy and water. 
 
 Bites from serpents received abroad are exceed- 
 ingly formidable injuries, and may be followed by 
 death within a few hours, so that whatever is to be 
 done must be done without delay. The part should 
 be at once sucked. This will not cause any harm to 
 the person who sucks the wound provided there are 
 no cracks upon the lips at the time. A tight bandage 
 should be applied above the wound either by means 
 of an elastic band, a leather strap, or a handkerchief 
 twisted tightly by means of a stick. The wound 
 should then be freely cauterised by means of a red- 
 hot wire or a red-hot cinder, or the part may be cut 
 out with a knife, or caustic, such as nitrate of silver, 
 may be applied to the wound; a red-hot wire is, 
 however, the best. 
 
 These bites are generally followed by chilliness, 
 and a feeling of great depression, so that stimulants, 
 especially preparations of ammonia, such as the 
 spirit of sal-volatile, must be freely given. A tea- 
 spoonful may be put into a wineglassful of water, 
 and the patient given a tablespoonful every quarter 
 of an hour. If there is any dread on the part of those 
 present in regard to the sucking of the wound, a similar 
 end may be served by the employment of a cupping- 
 glass, which may either be one of the orthodox sort, 
 
WOITNDS. 83 
 
 or, what will answer equally well, a wineglass, into 
 which a piece of burning paper has been put to 
 exhaust the air, inverted over the wound. As the air 
 becomes exhausted within it efficient suction will 
 take place. 
 
 What best to do in Case of Bites by a Mad 
 Dog or other Animal. 
 
 When a person is bitten by an animal supposed 
 to be mad, unless the actual fact of the animal's 
 madness is known, it should be kept and carefully 
 watched, and if it is found not to be suffering from 
 rabies no harm will result to the patient. This will 
 also save the individual a great deal of unnecessary 
 anxiety, because, when a dog is once destroyed, 
 there may be no means of ascertaining its previous 
 condition, and much mental worry may be gone 
 through, fearing the dog was mad at the time of its 
 biting. It should be borne in mind that, unless 
 the dog is suffering from rabies, no harm will result 
 from the bite, and the fact as regards the dog may 
 be easily ascertained by observing its behaviour for 
 a few days. Snapping at imaginary objects, with a 
 copious flow of saliva, and a convulsive closing of the 
 jaws, will strike the ordinary observer and put the 
 dog's madness beyond all question. 
 
 When a dog that is mad bites a person no harm 
 may result at the time, but at a variable period after- 
 wards, perhaps weeks or months, the symptoms of this 
 terrible disease may manifest themselves. The seat of 
 
84 woumjs. 
 
 the wound begins to liave an irritable appearance, 
 there is pain passing np the limb, headache is com- 
 plained of; a bright light is annoying, and when the 
 patient tries to drink, or a whiff of cold air blows 
 npon him, he is seized with tremor, saliva flows from 
 his mouth, and owing to the dry, irritable condition 
 of the throat there is a peculiar husky cough, not 
 unlike a bark. Fever then sets in, the pulse becomes 
 quick and irritable, there is wandering and an in- 
 ability to swallow food or drink, and the patient dies. 
 
 The method Mtkerto adopted in the treatment of 
 hydrophobia — tli 3 disease described above — has con- 
 sisted in suckin;^;- the wound, applying a red-hotwire, 
 or any other form of actual cautery, and then some 
 soothing alkaline lotion, such as ammonia-water, or 
 lead and opium, along with the administration of 
 stimulants, such as ammonia and brandy. Recently 
 inoculation has been tried by Pasteur, and persons 
 bitten by wolves, mad dogs, and other animals, have 
 undergone treatment. It is impossible yet to speak 
 with anything like certainty of the results, and con- 
 sequently difficult to recommend it as a legitimate 
 method of treating this disease. 
 
 HiEMOEEHAGE. 
 
 In our study of the vascular system it was observed 
 that bleeding from an artery differed from that of a 
 vein in the saltatory or jumping way in which it 
 came out of the wound. When an artery that is not 
 
HEMORRHAGE. 85 
 
 very large lias been divided, bleeding usually stops 
 after a time of its own accord, and the reason it stops 
 of its own accord is this: that the internal and 
 middle coats of an artery curl up inside the external 
 coat, which collapses beyond this point. This dimi- 
 nishes the stream of blood, allows the formation of a 
 clot from coagulation on exposure to the air, and so 
 allows the bleeding to stop. 
 
 When a vein is wounded the blood flowino- from 
 the cut surface will be recognised from that of arterial 
 blood by its darker colour, and its flowing in a con- 
 tinuous stream. The first thing, then, which anyone 
 has to determine in bleeding from any wound, is the 
 nature of the hsemorrhage. If it is venous ; unless a 
 large vein has been wounded, there will generally 
 not be much, difficulty in stopping it ; if, on the 
 other hand, it spurts out in any large jet, all that 
 one can do must be done to stop it as speedily as 
 possible, but medical aid ought always to be sought 
 at once. 
 
 What to do ix Case of Bleeding feozsj: a 
 Wound. 
 
 In the case of venous bleeding, a compress made 
 of a piece of lint folded up, or a piece of a handker- 
 chief, should be applied over the wound, and kept in 
 position by means of a bandage. This will gene- 
 rally suffice to check bleeding from a vein ; it also 
 answers in most cases in that from small arteries, 
 but some additional pressure may be required. 
 
86 HEMORRHAGE. 
 
 When a person suffers from wliat are known as 
 ■varicose, or enlarged veins, as of tlie leg, on sudden 
 exertion, the thinned wall may give way, and if 
 this occur out of doors, away from home, as some- 
 times happens, and the person continues to walk or 
 run, either to get home or to some house, a large 
 quantity of blood may be lost, or faintness may come 
 on, and the patient fall down when the bleeding may 
 be checked. I remember seeing a man in hospital 
 who had a varicose vein ruptured while walking 
 along the street, and who, becoming greatly alarmed 
 at the sight of blood, set off for the hospital running, 
 but, of course, the faster he ran the more rapidly he 
 bled, until he reached the place in a very blanched 
 and feeble condition. 
 
 There is nothing more easy than to stop this 
 sort of hsemorrhage, if only the person himself, or 
 his friends, do not lose their presence of mind. 
 Another case comes back to my recollection where a 
 woman, who suffered from a very bad varicose con- 
 dition of the veins of the leg, had one of them rup- 
 tured one morning. I was sent for at once, and on 
 reaching the house was pleased to find that the 
 neighbours had wrapped a shilling in a piece of rag 
 and bound it over the wound, and that in conse- 
 quence very little blood had been lost. 
 
 Suppose a person to be suffering from this affec- 
 tion, and either from sudden exertion, or by receiving 
 a blow upon it, a vein in the leg bursts, he should at 
 
HEMORRHAGE. 87 
 
 once lie down, remove the stocking, and place his 
 finger over the wound from which the blood is issu- 
 ing — very gentle pressure will suffice to aiTest its 
 flow — keep it there till some one comes with a com- 
 press and bandage, or put a coin, such as a penny in 
 a handkerchief, and place it over the part and tie it. 
 The patient must then stay in the recumbent posture 
 till medical aid is had. 
 
 A knowledge of the position of some of the arteries 
 
 Fm. 47.— Method op Arbesting Bleeding prom the Brachial, 
 Eadial, or Ulnar Arteries. 
 
 is very useful, because when one of them is injured, 
 bleeding, if it cannot be arrested by means of a pad 
 and bandage, may be checked by pressure of the 
 trunk of the vessel applied nearer the heart than the 
 wound. The artery passing along the upper arm to 
 the bend of the elbow is called the brachial. jSTow, if 
 this vessel is wounded in its course, or the radial or 
 ulnar into which it divides in its passage to the fore- 
 arm, bleeding may be checked by putting a round 
 
88 
 
 HiEMOERHAGE. 
 
 piece of wood, or other firm substance in the arm-pit, 
 and then fixing the arm tightly to the side, as in 
 fig. 47, or it may be checked by grasping the biceps 
 muscle between the thumb and fingers of the right 
 hand from the front or side or the triceps muscle 
 from behind, and pressing the artery against the 
 
 Fig. 4S.— Method op Arresting Bleeding prom the Brachial, 
 Radial, ok. Ulnar Arteries by Digital Compression, 
 
 bone, as in fig. 48. This should be practised on 
 the arm, and if the left hand be placed upon the 
 pulse at the place on the wrist already indicated, 
 and the other grasp the muscle of the upjper arm, 
 as explained above, when the brachial artery is com- 
 I)ressed, the beating of the pulse will cease. 
 
HiEMORHHAGE. 
 
 89 
 
 Bleeding frointlie foreann or hand can be checked 
 by placing a pad in the hollow of the elbow and bind- 
 ing the forearm to the upper arm vv^itli a bandage or 
 a handkerchief used as a bandage, as is shown in the 
 accompanying diagram. 
 
 In bleeding from a vj-onnd of tlie hand, such as 
 sometimes happens when a person receives a cut 
 between the thumb and forefinger, tliere may be 
 
 Fig. 49.— Pad and Bandage applied to check Bleeding 
 
 IN THE FOREAK?r. 
 
 difficulty in checking the bleeding, but by placing 
 the finger upon the wrist at the point where tbe 
 pulse is felt to beat, it can at once be arrested. 
 Wounds of the palm can generally, however, be 
 checked by a compress and bandage, if sufEcient 
 jiressure be applied. 
 
 In a.rterial bleeding from the thigh cr leg, pressure 
 ihouid be nn.de exactly in the middle of the groin, 
 
90 
 
 HEMORRHAGE. 
 
 midway between tlie anterior superior spine of the 
 ilium and the symphisis pnbis, or at the upper part 
 of the thigh, as in lig. 50. 
 
 Bleeding from wounds of the leg or foot may be 
 
 checked in the same manner as bleeding from the 
 forearm or hand by placing a pad in the hollow 
 behind the knee, and binding the leg firmly to the 
 
 Fig. 50.— Digitai. Compression of the Femoral Artery. 
 
 thigh. In the case of the elbow and knee, the pad 
 mnst be large enough to cause pressure upon the 
 artery when the leg or forearm is bound to the 
 thigh and upper arm respectively. 
 
 If pressure is applied at the root of the neck 
 above the collar-bone and at the side of the windpipe, 
 
H^MORRTIAGE. 01 
 
 the blood flowing in the carotid arter}' to the head 
 and neck may be arrested (see fig. 52). 
 
 When there is a troublesome bleedinsr from a 
 wound of the face, it may bo arrested by pressing 
 upon the fiicial artery in front of the muscle at the 
 angle of the lower jaw. 
 
 The method described above, where the fingers are 
 used to press upon the vessel, is what is called 
 
 Fig. 51. — Compress and Bandage applied to check bleeding 
 IN THE Leg or Foot. 
 
 digital compression, but bleeding may be arrested by 
 the employment of one or other form of tourniquet. 
 
 The oldest and one of the most easily applied forms 
 of this instrument is what goes by the name of the 
 twist tourniquet. It recommends itself because it can 
 be so readily improvised. Like most tourniquets, it 
 consists of three parts, a strap or bandage with 
 which to encircle the limb, a pad, and means of 
 tightening the bandage at will. A handkerchief, a 
 
92 
 
 HEMORRHAGE. 
 
 stone, a piece of cork or other hard substance, and 
 a stick, bj means of which leverage can be obtained 
 
 Fig. 52.— Compressing the Carotid Artery. 
 
 on the same principle as the rack pin is used by lorr j- 
 men, are all that is necessary. The following diagram 
 explains the method of applying this tourniquet : — 
 
 Fig. 53. — I:,[provised Tourniquet, 
 
 A piece of elastic tubing wound tightly round the 
 limb several times answers very well for arresting 
 
HiEMOEEHAGE. 
 
 93 
 
 hsemorrliage. One turn alone will be insufficienl; 
 the limb must be encircled several times before the 
 haemorrhage will be arrested (see fig. 53). 
 
 Other things may be used in place of the hand- 
 kerchief mentioned aboxe, such as a leather strap, a 
 brace, or the like. Another form of tourniquet, and 
 that which is in most general use in hospitals, is 
 
 Fig. 54.— Petit's and Es.marcu's Toukxiquets. 
 
 Petit's, which consists of a bandage, a buckle, a pad , 
 and a screw, by means of which the strap can be 
 tightened at will (see fig. 54.) 
 
 A strong linen bandage applied tightly round the 
 limb, one turn on top of another and moistened with 
 water after it is fastened, is also very efficacious in 
 checking bleeding. 
 
94 
 
 HEMORRHAGE. 
 
 It must always "be remembered that pressure must 
 be made in all these instances between the bleeding 
 point and the heart. 
 
 Bleeding from the IS'ose — How to Stop it. 
 
 Sometimes "bleeding from the nose is troublesome, 
 and may be difficult to check. Frequently cold- 
 water cloths, or ice, if it can be had, applied to the 
 forehead, will stop it. Elevating the arms above the 
 head is most useful in causing this form of bleeding 
 to cease. Seizing the nose between the fingers and 
 squeezing the sides together will often suffice, but 
 these failing, the syringing of the nostrils with 
 vinegar should be tried, or hot water, to which some 
 common salt has been added. 
 
 Should these methods fail, it will be necessary to 
 send for medical assistance, as plugging of the 
 nostrils may be required, and this, of course, neces- 
 sitates the presence of a surgeon. 
 
 Bleeding after the Application of Leeches — 
 How TO Stop it. 
 
 Leeches are not so much used now as formerly, 
 but occasionally there is troublesome bleeding after 
 they have been removed. A crystal of iron alum 
 laid upon the wound is generally sufficient to check 
 the bleeding. Sometimes dried alum and tannic 
 acid are employed for the same purpose, but if the 
 
n^MOKRHAGE. 95 
 
 iron alum fail it is hardly necessary to try either of 
 the other two. Should the patient be a long way 
 from medical aid, and those in attendance have the 
 courage to do it, two strong needles run through the 
 skin crosswise, entering beyond the bleeding point, 
 on the sound skin, going underneath the wound, and 
 out at the sound skin beyond, and a piece of linen 
 thread tied round them, will seldom fail in producing 
 the desired result. 
 
 Bleeding after Extraction op a Tooth — How 
 
 TO Stop it. 
 
 Sometimes after a tooth has been extracted there 
 is troublesome haemorrhage. A small crystal of iron 
 alum, pressed tightly into the cavity left by the 
 removal of the tooth, will generally cause the bleed- 
 ing to stop. Strong solution of the perchloride of 
 iron, in glycerine, applied on a pledget of lint, and 
 pushed tightly into the cavity, is also useful. 
 
 Bleeding after Confinement — How to Stop it. 
 
 Sometimes after delivery a woman is seized with 
 sudden snd severe hsemorrhage, especially when no 
 medical attendant has been with her in her confine- 
 ment. Medical assistance should be sought at oncCj 
 and in the meantime the pillows should be removed 
 from under the patient's head. She must, on no ac- 
 count, be allowed to raise herself from the recumbent 
 position, and should be only lightly covered with bed- 
 
96 lliEMORKHAGE. 
 
 clothes. Tlie hands of anj one present should then 
 be placed on the lower part of the belly and moved, 
 pressing deeply down with a sort of kneading move- 
 ment, and if the womb is felt contracting into a hard 
 round ball beneath the hand it should be grasped 
 tightly, and a firm hold kept of it till the arrival of 
 the , physician. Some tepid milk and water may be 
 given to the patient, but no hot drinks must be 
 administered, as these have a tendency to keep the 
 bleeding up. 
 
 Bleeding feom the Umbilical Cokd — How to 
 
 Stop it. 
 
 It may happen from tying the cord with too thick 
 tape, or not sufficiently tightly, that an hour or so 
 after it has been divided blood will be seen coming 
 through the child's clothes, from the blood vessels 
 not having been sufficiently compressed at the time. 
 When this accident occurs, the child should be at 
 once undressed, and the cord tied immediately 
 behind the other ligature with three or four 
 thicknesses of worsted or linen thread, and care 
 must be taken to see that all bleeding is at an 
 end before the cord is again put up, and the child 
 dressed. 
 
 Bleeders. 
 
 Some peoiilo, owing to a constitutional peculiarity 
 which appears to be hereditary, have a much greater 
 tendency to suffer from hFemorrhnge than others. 
 
HiEMORRHAGE. 97 
 
 and ofton in these cases the prick of a pin may be 
 followed by troublesome bleeding, and the extraction 
 of a tooth, or a cut, may cause alarming or even fatal 
 consequences. A slight pinch of any part of the 
 body, or a blow or knock, is generally followed by a 
 blueish mark : the result of blood being effused into 
 the cellular tissue. Whenever a person is known to 
 have this tendency, every possible care must be 
 taken to avoid wounds of every sort, and no time 
 should be lost in sendinsr for medical aid. Till 
 professional help is got, if the patient has cut 
 himself, or received a wound of any kind, the joad 
 and bandage should be tried, and, this proving 
 ineffectual, the application of dried alum, iron alum 
 tannic acid, ice, or turpentine, may be tried, and 
 should these not succeed, digital compression of the 
 nearest arterial trunk. 
 
 Internal Bleeding — What to Do. 
 
 Under this heading may be mentioned bleeding 
 from the lungs and stomach. The former may occur 
 in the early stage of consumption, and often gives 
 rise to a good deal of anxiety, both to the patient 
 and his friends. This form of bleeding may come 
 on during^ a fit of couo'hins^. It is disting^uished from 
 that of the stomach by being bright scarlet in colour, 
 and frothy owing to the admixture of air. That 
 from the stomach is dark in colour, and does net 
 present the frothy appearance of blood coming from 
 the lungs. In these cases, keep the apartment cool, 
 
98 LOSS OF CONSCIOUSNESS. 
 
 the patient quiet in the recumbent position, and as 
 free from disturbance as possible. Ice may be sucked, 
 or cold water where ice cannot be had. Of course; 
 medical aid should be sought at once. 
 
 LOSS OF COl^SCIOUSlSrESS. GENEEAL 
 OBSEEVATIONS. 
 
 It may happen that among the cases of emergency 
 in which Eirst Aid is necessary, may be one in which 
 a patient has been found in an insensible condition, 
 and in regard to which it may become necessary to 
 determine, as far as possible, the cause of this loss 
 of consciousness, and to do something, either till the 
 patient recover, or until medical aid can be got. To 
 do this is not always so easy a matter as it may at 
 first sight appear, and sometimes even the skilled 
 practitioner has difficulty in determining the exact 
 cause, as fainting, epilepsy, apoplexy, alcohol, albu- 
 minurea, or Bright's disease of the kidneys, and con- 
 cussion of the brain, may all give rise to this condition. 
 
 It sometimes happens that a man is picked uj) in 
 the street in an unconscious state, is supposed by 
 the policeman, who frequently knows nothing about 
 it, to be drunk and incapable, while he may be suffer- 
 ing from apoplexy. Under this impression he is 
 walked off to a police station, where, instead of 
 sleeping off the effects of his su^^posed debauch, an 
 appearing all right next morning, he may be found 
 dead. 
 
LOSS OP CONSCIOUSNESS. 99 
 
 Fainting. 
 
 What we call fainting is the result of anaemia, or 
 a bloodless condition of the brain. It may arise 
 from many causes : such as a close atmosphere, 
 getting into a crowd, fright, bad smells, excessive 
 pain, or loss of blood, as from the bowels, the lungs, 
 or a wound. In this afPection, there is pallor of the 
 face, coldness, perspiration, especially seen in large 
 drops on the face ; feeble, shallow, and irregular 
 breathing, often sighing or gasping in character. 
 The heart's action is feeble ; the pulse at the wrist is 
 small, or, it may be, imperceptible ; there may be 
 noises in the ears, indistinctness of vision, and 
 giddiness. 
 
 When recovery sets in, a condition of reaction 
 manifests itself. The coldness of the extremities 
 gives way to a feeling of warmth, and the pallor of 
 the surface is succeeded by a return of colour, and a 
 glow is felt over the w^hole body. The pulse becomes 
 stronger, and all the unpleasant mental phenomena 
 pass away. 
 
 What to do in Cases op Fainting. 
 
 Painting being the result of a bloodless condition 
 of the brain, the first step in the treatment, and that 
 which naturally suggests itself, is to assist the return 
 of blood to that organ. In order to do this, the 
 
100 LOSS OF CONSCIOUSNESS. 
 
 patient should be at once laid upon his back, or tbe 
 bead tbrust forcibly down between the legs. All con- 
 stricting articles of clothing must be removed from 
 the neck, and strong smelling salts may be applied 
 to the nostrils. Cold water should be sprinkled over 
 the face, or a handkerchief, dipped in cold water, 
 may be used to stroke the face with. If the patient 
 is in a heated atmosphere, he should be at once 
 removed to one that is cooler, or the window thrown 
 open, that the air may blow upon him. A little spirit 
 of sal-volatile, say half a teaspoonful, may be given 
 by the mouth, and, if ^ necessary, mustard should be 
 applied to the calves of the legs and feet. 
 
 A gentleman came to consult me one day on 
 
 account of a painful carbuncle from which he was 
 suffering. I found it necessary to apply caustic in 
 the form of nitrate of silver to it. He seemed a 
 strong muscular man, but I observed shortly after 
 the caustic had been applied to the sore that he 
 became very pale; his breathing changed in cha- 
 racter, and he drew occasional sighs. I saw he 
 wris about to faint, and assisted him to the sofa ; in 
 doing so, it was apparent that he had in great 
 measure lost the use of his legs. He sank down 
 upon the sofa, and a cold perspiration bedewed his 
 face. I gave him thirty drops of spirit of sal- volatile, 
 and the same of tincture of cardamoms in water. 
 He soon came round, and told me that, when he sank 
 into the sofa, he lost sight of everything for a 
 moment. 
 
LOSS OF CONSCIOUSNESS. 101 
 
 Hysteria. 
 
 This afioction is chiefly met with in the female 
 sex. It manifests itself, in the majority of instances, 
 in young women from the time of puberty to the 
 age of twenty-five, and again at the change of life, 
 at which times there is more or less disturbance of the 
 sexual apparatus. Frequently b3^standers are greatly 
 alarmed when an attack of hysteria comes on, and 
 the accounts which they give of the patient's 
 condition sound very dreadful. 
 
 The hysterical attack may come on with intense 
 sobbing or immoderate laughter, or crying and 
 laughing may alternate with one another. There is 
 always something exaggerated about the outward 
 manifestations of hysteria, which removes it from the 
 category of the more serious maladies. There is 
 frequently wild tossing about of the arms, the hair 
 is dishevelled, the face is generally pale, and com- 
 plaint is made of a suffocating feeling in the throat. 
 The patient does not lose consciousness, although 
 she may feign to be deaf to everything you say. In 
 all her actions during the time the fit lasts there is 
 a wonderful reo'ard for self. 
 
 The hysterical patient finds greatest comfort in 
 having round about her a number of sympathetic 
 friends, and the more consideration they display for 
 her during the attacks the more she will require at 
 
102 ^OSS OF CONSCIOUSNESS. 
 
 their hands. To be neglected is what she greatly 
 dislikes, and she generally provides against this by 
 choosing an opportune moment for the coming on of 
 her illness. 
 
 What to do in cases of Hysteria. 
 
 During the attack, or fit, as it is called, the 
 sympathy of the bystanders and the expression of 
 pity which they manifest aggravate rather than 
 assuage the disease. The patient must be dealt 
 with kindly, but firmly, she must be told at once to 
 stop her sobbing, and if she sees you mean what you 
 say it will soon cease. Loosen the dress and remove 
 anything tight from the neck. Give a teaspoonful 
 of spirit of sal-volatile in a wineglassful of water. 
 If she appears to be unconscious, and remains deaf 
 to your entreaties, cold water dashed upon the face 
 will generally be sufiicient to restore her. When 
 one in a family suffers from this affection, unless she 
 is taken in hand at once and dealt with firmly, a 
 great amount of trouble is in store for the other 
 members when the habit becomes established. 
 
 Tills aifection ought not to be treated as if it were 
 altogether a sham, nor should any one suffering from 
 it be roughly dealt with by those who are closely 
 associated with them ; there is generally some con- 
 dition of ill-health to account for the hysterical 
 phenomena, whatever form these may take, and 
 medical aid should be sought in order to restore the 
 body to its normal condition. 
 
LOSS OF CONSCIOUSNESS. 103 
 
 Fits. 
 
 The Epileptic Fit is tlie most characteristic form 
 iu which the disease called E^ileiJay manifests itself. 
 Epilepsy has also been called the Fatal Disease, the 
 Falling Sickness, and the subjects of it were at one 
 time believed to be possessed with the devil. It is 
 a disease very grave in its nature, and affects the 
 health and future prospects of those who suffer from 
 it. In its onset it is sudden, and the first intimation 
 the bystander gets of what is going on is the utter- 
 ance of a loud scream, and on turning his head in 
 the direction from which it comes the patient will 
 generally be found lying on the ground. 
 
 So frequently without warning, and so violent is 
 the fit, that without the ability to escape to a place 
 of safety, the sufferer is thrown down with great 
 force upon the ground, his head striking anything 
 that may come in its way, and perfectly unconscious 
 of the harm he may be doing himself. 
 
 During the first stage, the duration of which is 
 less than a minute, the face is pale and death-like, 
 while the muscles are rigid as bars of iron. The 
 tongue is thrust violently forward, and respiration 
 ceases. At the conclusion of this stage that which 
 is generally observed by onlookers takes place. The 
 muscles begin to twitch violently, the face becomes 
 
104 LOSS OP CONSCIOUSNESS. 
 
 turgid and dark red in colour, and a bloody froth is 
 seen to ooze from the mouth, the tongue being bitten 
 by the spasmodic contraction of the jaws. 
 
 The second stage lasts from about thirty seconds 
 to a couple of minutes, the convulsive twitching of 
 the muscles ceases, and the patient passes into a 
 condition of profound stupor, during which he may 
 be pinched, pricked, or burnt without being con- 
 scions of it. He may remain in this condition for 
 upwards of a quarter of an hour, when he will 
 open his eyes and look round with a dazed expres- 
 sion. Gradually he comes to himself, but for some 
 time his mental faculties are dull, and he complains 
 of headache and failure of memory. 
 
 What to do during an Epileptic Fit. 
 
 If the patient is known to snifer from this disease, 
 and he gives utterance to the cry already mentioned 
 as characteristic of the onset of a fit, he should be 
 prevented from hurting himself, by being caught in 
 the arms of a bystander, laid gently down upon his 
 back, with a pillow under the head, and everything 
 tight should be at once removed from the neck. If 
 possible get a cork, or something soft, inserted 
 between the teeth, so as to prevent hhn biting his 
 tongue, then wait patiently till the fit is over. 
 'No effort ought to be made to stop the convulsive 
 movements of the body, as this only makes matters 
 worse, although it is not unusual for the medical 
 
LOSS OF CONSCIOUSNESS. 
 
 105 
 
 attendant to be told — by way of proving the severity 
 of the attack — that it took so many people to hold 
 the patient down. 
 
 Infantile Convulsions. 
 
 During infancy and cliildhood first aid may fre- 
 quently have to be rendered in cases of convulsions. 
 These are often very alarming to the parents and 
 friends, and justly so, because the child may die 
 during an attack. The nervous system during this 
 period of life is highly sensitive, and the irritation 
 caused by indigestible articles of food, teething, and 
 worms, is sufficient to give rise to this disease. 
 
 When an attack is coming on the nervous system 
 gives evidence of being profoundly affected, and the 
 careful observer will be able to interpret aright the 
 sudden startino-s and twitchins^s that now manifest 
 themselves. In addition to these, there is often 
 drowsiness and fretfulness, the sleep is disturbed, 
 the eyes have a wild look about them, and the 
 thumbs are frequently carried across the palms of 
 the hands. I knew a lady who, observing the mus- 
 cular startings and twitchings, already spoken of, in 
 the case of her child some eight months old, and 
 knowing their import, at once looked to the gums, 
 and finding them red and irritable-looking, tried to 
 lance them with her pocket-knife, and had partially 
 succeeded before I got to the house. 
 
 When the attack sets in the child is suddenly 
 
106 
 
 LOSS OF CONSCIOUSNESS. 
 
 seized with violent twitchings of the muscles of the 
 face and limbs, the features are distorted, the face 
 becomes flushed, consciousness is lost, the pulse 
 becomes rapid, and the temperature of the body 
 rises. 
 
 What to do in Cases of Convulsions. 
 
 If one has "been fortunate enough to observe tlie 
 premonitory tv^itchings of the muscles, and to under- 
 stand what they mean, medical aid will have been 
 sought, and every endeavour made to ascertain the 
 cause. If, however, as more usually happens, the fit 
 takes everyone by surprise, the state of the stomach 
 and gums should at once be attended to. If the 
 child has eaten berries, and has swallowed them, 
 skins and all, or if unripe fruit has been eaten, it 
 may be pretty certainly taken for granted that this 
 is the cause. In these circumstances an emetic may 
 be given with advantage, and for this purpose a tea- 
 spoonful of ipecacuanha wine may be mixed in a 
 wineglassful of tepid water and given every quarter 
 of an hour, with drinks of tepid water between, till 
 vomiting takes place. 
 
 If some hours have elapsed it might be a waste of 
 time to give emetics, but instead an enema of soap 
 and water may be given by the bowel. A sheet may 
 be wrung out of warm water and wrapped round the 
 child from the neck to the feet, and one or two 
 blankets over the top, and it may be allowed to 
 
LOSS OP CONSCIOUSNESS. 107 
 
 remain in tlie pack for an hour, or a warm bath may 
 be given, or the feet may be put into mustard and 
 water, and allowed to remain for a quarter of an 
 hour or twenty minutes, while cloths wrung out 
 of cold water should be applied constantly to the 
 head, 
 
 Uk.emic Convulsions. 
 
 In the course of disease of the kidneys convulsions 
 may occur, usually these are preceded by persistent 
 vomiting, headache, dimness of sight, or sudden 
 blindness. 
 
 The cause of the convulsions is the accumulation 
 in the blood of the poisonous materials which in 
 health pass away in the urine, and their action on the 
 nervous centres in the brain. 
 
 The fit has many of the features of epilepsy, and 
 it may be difficult to ascertain its true character. 
 Usually, however, the well-kno\\Ti cry which ushers 
 in an epileptic fit is absent, and if the urine is sup- 
 pressed, or has been scanty for some time, and in 
 addition there is swelling of the face and limbs, it 
 may be assumed that the patient is suffering from 
 this disease. 
 
 What to do in Case op Uremic Convulsions. 
 
 Send at once for medical aid, and meanwhile 
 apply hot fomentations, poultices, or dry cupping 
 
108 LOSS OF CONSCIOUSNESS. 
 
 to the loins. Dry cupping may be accomplislied by 
 putting a few drops of metliylated spirit on a piece 
 of blotting paper, placing it in the bottom of a wine- 
 glass, setting fire to it, and inverting it over the 
 part it is desired to cup while still in a state of 
 ignition. 
 
 Loss OF Consciousness peom Apoplexy. 
 
 Wliexi a person has fallen down in an apoplectic fit, 
 the appearance which he presents is somewhat as 
 follows : he lies breathing heavily, his cheeks being 
 puffed out with each act of expiration, the face has a 
 red, congested look, the pulse is full and generally 
 slower than in health, there is complete unconscious- 
 ness^ and speaking has no effect in rousing the 
 patient from his deep stupor. The pupil of the eye 
 will be found insensible to light, and is generally 
 dilated. Paralysis of one or other side of the body 
 may be detected. 
 
 In coming to a correct understanding as to what is 
 the matter, it will be helpful to note the age of the 
 patient, as apoplexy is, usually speaking, a disease 
 cf middle or advanced life. If we have had any 
 previous acquaintance w^ith the patient we may have 
 had warning of what was coming, flushings of the 
 face, a swollen condition of the veins of the forehead 
 and neck, dusky hue of the lips, giddiness, moment- 
 ary attacks of forgetfulness, noises in the ears, 
 bleeding from the nose, drowsiness, with heavv 
 
LOSS OP CONSCIOUSNESS. 109 
 
 disturbed sleep, coldness of tlie feet while tlie head 
 is hot and burning, and constipation, are all pre- 
 monitory symptoms of this disease. 
 
 It must he borne in mind that the breath of one in 
 an apoplectic lit may smell of alcohol, and 3^et the 
 case be one of genuine apoplexy, so that where- 
 ever there is any doubt as to whether the case is one 
 of intoxication or apoplexy we ought always to act 
 as if it w^ere the graver of the two. 
 
 What to do in Case of an Apoplectic Fit. 
 
 If we liave made iip our minds that the case with 
 which w^e have to deal is one of apoplexy, we should, 
 in rendering first aid, prevent all unnecessary move- 
 ment, raise the head and remove everything tight 
 from the neck, then apply ice in an india-rubber 
 bag or bladder to the head, or cold water cloths if 
 ice cannot be had. Put the feet in mustard and 
 water, or apply mustard leaves or poultices to the 
 calves of the legs ; give stimulating enema.ta, con- 
 sisting of one ounce and a half of castor oil, half an 
 ounce of turpentine, and gruel to make a pint. Of 
 course medical aid should be procured as soon as 
 possible. 
 
 Loss OF Consciousness feom Intoxication. 
 
 In the stupcr of intoxication the patient may, by 
 loud speaking, be got to respond j the pulse is 
 
110 LOSS OF CONSCIOUSNESS. 
 
 frequent, the breathing is slow, and is not as a rule 
 accompanied by tlie puffing out of the cheeks which 
 characterises the breathing of apoplexy. The face 
 may be either flushed or pale, the smell of the breath 
 will generally reveal whether or not the patient has 
 been drinking, and if we have known him before, his 
 previous habits, and now his general appearance and 
 age, will help us in coming to a right understanding 
 in regard to the nature of the case. 
 
 What to do in case op loss op Consciousness 
 PEOM Intoxication. 
 
 If certain of tlie cause, emetics may be given, 
 such as a tablesponful of mustard in tepid water, or 
 twenty grains of sulphate of zinc, or the same of 
 powdered ipecacuanha. If exposed, he should be 
 removed to a warmer atmos^Dhere, and strong tea or 
 coffee may be administered. Cold water poured 
 upon the head is sometimes useful. 
 
 Loss OP Consciousness from Concussion of 
 the Brain. 
 
 Concussion of the brain may result from blows 
 upon the head or from a fall, and may be 
 either so slight that beyond temporary giddiness, 
 and confusion of ideas, the patient ails nothing, or 
 he may be completely unconscious. The uncon- 
 sciousness may remain for a few minutes, or it may 
 last for many hours. The patient has generally a 
 
LOSS OP CONSCIOUSNESS. Ill 
 
 very collapsed appearance, the muscles are flaccid, 
 the pulse is small and irregular. The breathing is 
 irregular, with comparatively long intervals between 
 the respirations, the pupils are insensible to the 
 stimulus of light. 
 
 If spoken to loudly enough he will generally make 
 an effort to reply; in aj)oplexy loud sj)eaking pro- 
 duces no effect. When the insensibility is f>assing 
 away there is usually vomiting, the pulse becomes 
 fuller, stronger, and more regular, the face gets 
 flushed and hot (it was pale and cold before), he 
 then wakens up as if from sleep, rubs his eyes, and 
 begins to look about him with an uncertain sort of 
 air as if trying to understand his surroundings. 
 
 What to do in case of Concussion or the Brain. 
 
 In concussion of the brain the proper treatment 
 is to move the patient as little as possible, to remove 
 all tight articles of clothing from about the neck, 
 apply hot bottles to the feet and sides, or hot bricks 
 wrapped in flannel, a mustard poultice or a mustard 
 leaf may be applied over the stomach, no stimulants 
 are to he given. Medical aid must be sought without 
 delay. 
 
112 FOREIGN BODIES IN THE NOSE. 
 
 FOREIGN BODIES IN THE NOSE. 
 
 s. 
 
 While children are playing with each other, pea? 
 beads, cherry-stones, or sweets may find their way 
 into the nostrils. The parents often become excited, 
 and in their efforts to extract them only pnsh them 
 further back, and the mncous membrane becomes 
 irritated by the unsuccessful attempts that are thus 
 made. 
 
 What to do when Eoeeign Bodies aee in the 
 
 Nose. 
 
 If the child is old enough to understand what is 
 said to it, and can do as it is told, it should be asked 
 to draw a deep breath by the mouth, and holding 
 the fingers pressed tightly against the free nostril, 
 blow forcibly through the one in which the obstruc- 
 tion exists, when it may frequently be dislodged. 
 Failing this, the nostril should be grasped behind it, 
 and the end of a small flat article, such as the handle 
 of a salt spoon, be introduced with care beyond it, 
 and an effort made to scoop it out. 
 
 A child was "brought to me some time ago with a 
 large bead in the right nostril. I took the small 
 spoon of the surgical instrument, called the director, 
 and insinuating it behind the foreign body, ex- 
 tracted it without any difficulty. A stream of water 
 
FOREIGN BODIES IN THE NOSE. 113 
 
 injected up the free nostril, if the mouth be kept 
 open, will pass into the one in which the obstruction 
 exists and may suffice to dislodge it. 
 
 The same may be done by taking a piece of india- 
 rubber tubing and using it as a nasal douche. Put 
 one end into a basin of water, let the other hans: 
 down till water begins to flow from it, then introduce 
 this end into the free nostril, and by elevating the 
 basin above the head a stream of water will pass -up 
 the one nostril and coming down the other may drive 
 the foreign body before it. It must be remembered 
 that the mouth is to be kept open. 
 
 If the efforts to dislodge the foreign body are 
 
 fruitless after trying a few times, or should seem 
 to push it further back, medical aid had better be 
 sought, or the child taken to the doctor, lest it be 
 driven back and fall into the larynx. 
 
FOREIGN BODIES IN THE EAR. 
 
 FOEETGN" BODIES IN THE EAR. 
 
 If the diagram of the ear, Eig. 55, be looked at, it 
 will be seen to consist of an outer soft part, the 
 auricle, a canal running in from that the external 
 auditory meatus, which is closed at its inner end by 
 
 Fig. 55.— The Organ of Hearing, as seen on making a Transverse 
 Section through the Side-wall or the Skull. 
 
 a, the pinna ; h, the external auditory meatus ; c, the membrana 
 tympani ; d, the cavity of the tympanum ; /, the malleus ; g, the anterior 
 semi-circular canal ; e, the Eustachian tube. 
 
 the membrane called the tympanic membrane, or 
 drum-head of the ear. 
 
 This canal is what now concerns us, for foreicfn 
 bodies similar to those found in the nose are apt to 
 find their way in like manner into the ear, and in 
 
FOREIGN BODIES IN THE EAR. 
 
 115 
 
 addition we may have insects pass into the external 
 auditory meatus and prove troublesome. Usually 
 speaking, more harm results to the ear from ill- 
 directed efforts made to extract the offending body 
 Ihan if it had been left alone, and serious and irre- 
 parable injury has often been done by careless prob- 
 ing* about in the canal of the ear. 
 
 To REMOVE Foreign Bodies prom the Ear. 
 
 If an insect has found its way into the ear, 
 make the person hold his head on one side and fill 
 
 Fig. 5G.— The Malleus, 
 
 on Hammer Bone of 
 
 THE Ear. 
 
 Fig. 57. — The Ixcrs, 
 
 OR Anvil Bone of 
 
 THE Bar. 
 
 Fig. 58. — The 
 Stapes, or Stir- 
 rup Bone of 
 THE Ear. 
 
 the canal with olive oil, it wiU generally float upon 
 the surface and thus be got rid of. If a pea, bead, 
 cherry-stone, or other such article have found its way 
 into the ear-canal a small blunt instrument may be 
 used as a scoop. It should be gently insinuated, 
 aloug the upper surface of the canal, beyond the body 
 to be removed and then drawn outwards. Should 
 this fail the head of a hairpin may be used as a snare, 
 and observing the same caution we must endeavour 
 to get over the foreign body and so extract it. 
 
116 
 
 FOREIGN BODIES IN THE EAR. 
 
 There is yet one other thing that may be tried, 
 
 that is, to direct a stream of water from a syringe 
 along the upper part of the ear-passage, and in order 
 to render it more direct the npper part of the ear 
 
 Fig. 59. — DiAGnA:\niATic View or the parts composing the Organ 
 
 or Hearing. 
 
 a, the pinna; b, the external auditory meatus; d, the head of the 
 malleus or hammer bone ; e, the processus gracilis, or slender process of 
 the malleus ; /, its handle ; g, the incus ; h, its short process ; i, its long 
 process ; Jc, the tubercle for articulation with the head ; I, the stapes ; 
 m, the base of the stapes, or that portion placed in the finestra ovalis ; 
 n, the superior semi-circalar canal; o, the posterior canal; p, the hori- 
 zontal or external; q, the first turn of the cochlea; r, the apex of the 
 cochlea. 
 
 should be drawn backwards and upwards. It must 
 again be impressed upon the mind that great and last- 
 ing mischief may be done if anything like force is 
 used, so that if, Avith the utmost gentleness, the 
 remedies suggested be unavailing, it will be better to 
 obtain medical advice as soon as possible 
 
FOREIGN BODIES IN THE EYE. 
 
 117 
 
 FOEEIGl^ BODIES IN THE EYE. 
 
 Owing to its extreme sensitiveness any foreign 
 body getting into the eye, unless it is at once re- 
 moved, quickly sets up inflammation. Many particles 
 of dust and motes of various kinds wlien tliey enter 
 the eye cause an increased flow of tears, and are 
 often in this way got rid of. The little gland which 
 
 Fig. 60.— Muscles op the Left Orbit, viewed rivo^r the outer 
 
 SIDE. 
 
 a, the levator palpebroe superioris ; h, the superior rectus; c, ihe 
 inferior rectus ; e, the external rectus ; g, the inferior oblique muscle ; 
 /, the superior oblique ; o, the optic nerve ; d, the internal rectus. 
 
 performs the important office of secreting the tears 
 by which the eye is lubricated is situated at the 
 upper and outer aspect of the eye, and the little 
 channel by Avhich they are drained away into the 
 nose is placed at the inner angle, so that the course 
 of the tears is such as to drive any loose body to 
 the inner part of the eye, where it may be removed 
 almost unconsciously with the point of the finger, or 
 be taken away with the corner of a soft handkerchief. 
 
118 FOREIGN BODIES IN THE EYE. 
 
 Sometimes, however, foreign bodies are not so 
 easily got rid of, and then ifc may become necessary 
 to turn tbe upper eyelid inside out. This can be 
 done by taking the eyelashes between the thumb and 
 forefinger of one hand, drawing the eyelid down- 
 wards and forwards and pressing the end of a pencil, 
 a pen-holder, the back of the blade of a knife, or the 
 like article deeply doAYu over the globe of the eye ; 
 turn the eyelid up. 
 
 Tig. G1. — ^Vertical Sectton of the Left Okbit with its 
 contents. 
 
 a, levator palpebrse superioris; b, the superior rectus; o, opiic nerve, 
 e, inferior rectus ; /, elastic cushion of fat upon which the eye rests ; 
 6', the tarsal cartilage ; d', the cornea ; h', the lower eyelid ; b, the crystal- 
 line lens J c", the anterior and inferior part of the sclerotic, c, the cornea. 
 
 What to do when a Foreign Body is in the 
 
 Eye. 
 
 When a foreign body has found its way into the eye; 
 
 and is not removed in any of the ways already indi- 
 cated, it becomes necessary to endeavour to extract 
 it. If the offending substance is not embedded in 
 the globe of the eye it will generally be easily re- 
 moved, either with or without everting the lid, by 
 making use of the corner of a soft pocket-handker- 
 
FOREIGN BODIES IN THE EYE. 119 
 
 chief, or a camel-hair pencil that has been moistened 
 with water or olive or castor oil. 
 
 It sorietimes happens that the foreign body, in- 
 stead of being loose, is embedded in the substance of 
 the eye itself. In this case great care has to be 
 exercised to prevent the patient rubbing the e^^e, 
 which is the first natural impulse of most people 
 when anything irritates them in that region, because 
 the more the eyelids are rubbed the deeper does the 
 substance become driven in. 
 
 Blacksmiths may meet with this accident from 
 sparks from the anvil, stone-masons from minute 
 chips flying from the stone they are dressing, quarry- 
 men, miners, and others from like causes. Fre- 
 quently the particle is so minute that it is only seen 
 with difficulty, but whenever an eye is inflamed and 
 you are told that something has got into it, a very 
 careful examination must be made, lest the presence 
 of the foreign body be overlooked, and the sight in 
 consequence be impaired or destroyed. 
 
 If the particle be detected a camel-hair pencil, 
 dij)ped in water or oil, should be passed over, and an 
 efibrt be made in this way to extract it ; failing this, 
 a blunt-pointed instrument may be carefully passed 
 across the surface. Should these attempts proA^e 
 unsuccessful in dislodging it, the patient should be 
 taken without delay to his medical attendant. 
 
 Should a violent inflammation be lighted up sud- 
 
120 FOREIGN BODIES IN THE EYE. 
 
 denly without apparent cause, particularly if one eye 
 only is affected, a foreign body should always he 
 suspected, and even if the examination by an un- 
 skilled person be unable to detect anything in the 
 eye it will be better to seek medical advice, lest the 
 sight be damaged. 
 
 A not uncommon and dangerous form of injury 
 
 is that from lime splashed into the eye. Quicklime 
 acts as a powerful caustic, and often causes complete 
 blindness, by destroying the vitality of the cornea. 
 Even when the conjunctiva only is affected, the eye 
 may be seriously disabled by a growing together of 
 the raw surface of lid and ball. The lime should, 
 of course, be instantly washed out as thoroughly as 
 possible with water, and any that may remain should 
 be neutralised by bathing with a teaspoonful of 
 vinegar in a glass of water, or rendered inert by 
 sweet oil — the latter is equally efficient, and more 
 soothing. 
 
 In case of injury by acid, one part of lime-water 
 to three of water may be used, or the eye may be 
 freely bathed with milk. 
 
CHOKING, 
 
 121 
 
 CHOKING. 
 YThen the food tbat is taken into the mouth Las 
 
 Fig. 62.— Yerxical Section of Face and Neck. 
 a, tongue; b, mouth; c, hard palate; e, soft palate;/, uvula; g, 
 epiglottis; }i, larynx; j, pharynx; t, esophagus; I trachea or wmd- 
 T)iT)i The unbroken line indicates the single route taken by the tood, 
 the dotted double line that taken by the air through the nose and mouth 
 to the air-tube. 
 
 been sufficiently masticated it is passed on to the 
 
122 CHOKING. 
 
 back of the tongue, from which, in ordinary circum- 
 stances, it is passed into the pharynx, from which it 
 is propelled along the oesophagus to the stomach. 
 It is prevented from passing into the windpipe by 
 the bending back of the epiglottis, and into the 
 nose by the approximation of the uvula, soft palate, 
 and posterior wall of the pharynx. 
 
 It may happen, however, that from laughing or 
 talking during eating, the food, instead of passing 
 from the pharynx into the oesophagus, finds its way 
 into the upper part of the larynx, and then a person 
 is said to choke. When this takes place violent 
 coughing will immediately ensue, and unless the 
 offending substance is dislodged, all the muscles of 
 the chest will be brought into play in a convulsive 
 paroxysm to get rid of it. Meanwhile the face is 
 becoming dark purple in colour, owing to air being 
 prevented from entering the lungs, and the person will 
 seize his throat, toss his arms wildly in the air, and 
 ultimately fall down on the floor; unless relief is 
 speedily obtained, death will ensue. This accident is 
 liable to happen to hungry persons eating hastily, or to 
 children, and requires the greatest self-control and 
 presence of mind on the part of those who are 
 present in order to be of any use. 
 
 What to do in case of Choking. 
 
 The subtance which causes the choking may either 
 be at the top of the throat at the entrance to the 
 
CHOKING. 12o 
 
 f::ullet or lower down. If at the upper part of the 
 throat, prompt action will often remove it, either by 
 thrusting the finger and thumb into the mouth and 
 pulling the obstruction away, or if it cannot be 
 reached so as to pull it away, a piece of Avhalebone, 
 a quill, or even a penholder— anything at hand — 
 should be seized and pushed doAvn as a probang, so 
 as to force the substance down the gullet. Tickling 
 the back of the mouth with a feather, so as to pro- 
 duce sudden retching, will sometimes dislodge it. 
 A sharp blow on the back will perhaps displace it, 
 or a sudden sj^lashing of cold water in the face, 
 causing involuntary gasping. 
 
 Sliould the patient become insensible before relief 
 can be afforded, it must not be assumed for certain 
 that death has taken j)lace, and such remedies as 
 dashing cold water on the face and On the chest, 
 ap]3lying ammonia to the nostrils, and artificial 
 respiration, should be continued till medical aid 
 arrives. 
 
 "When any foreign substance, solid or fluid, be it 
 ever so small, as, for example, a crumb of bread or a 
 drop of water, passes into the windpipe, it immediately 
 occasions distressing cough and interrupted respira- 
 tion from spasm of the muscles at the top of the 
 windpipe ; and this is also called choking, but it is 
 altogether a different kind of action from the one 
 we have just been considering. The substance here 
 is always small, and is usually a dry isrumb o± bread 
 
124 CHOKING. 
 
 or ci drop of fluid draAvu accidentally into the wind- 
 pipe in tlie act of inspiration, whicli frequently occurs 
 from an incautious attempt at speaking wliile in the 
 act of swallowing. Quietude on the part of the 
 sufferer, and to refrain wholly from speaking, is all 
 that can be recommended. 
 
 lo 1112.7 bs doubted whether the common practice 
 of taking a little drink really does any good, but as 
 it is unattended by any evil it may be resorted to. 
 When you reflect that the oflending matter is in the 
 windpipe, and that the drink goes down the gullet, 
 it is perfectly clear that it cannot be washed down 
 as is commonly believed. Still, however, it is possible 
 that the act of swallowing the drink may, by sus- 
 pending for the time the action of breathing, allow 
 the muscles of respiration to recover more readily 
 from the state of spasm into which they have been 
 thrown by the irritation from the offending matter. 
 
 With this object in view, therefore, the drink 
 should be swallowed as slowly as possible, and for 
 the same reason, a voluntary suspension of breathing, 
 as long as can be done under the circumstances, 
 tends to lessen and shorten the state of distress. 
 Nature, however, generally removes the offending 
 cause by the efforts of the cough which is invariably'- 
 produced. 
 
 Paralytic patients are very liable to this species of 
 choking, and we have known a large piece of food 
 slip into the windpipe of such a person and produce 
 
CHOKING. \2^> 
 
 imminent danger of suffocation. Of* course, in sucli 
 cases, medical aid must be sought, and tlie surgeon 
 should be told the nature of the case in order that 
 he may bring with him the necessary instruments 
 for performing the operation of cutting an opening 
 into the windpipe. 
 
126 SPURIOUS CROUP. 
 
 SPUEIOUS CEOUP, OE LAEYNGISMUS 
 STEIDULUS. 
 
 A mother may be wakened up in the niglit 
 by a child breathing with curious crowing inspir- 
 ations, and she may become alarmed lest the child 
 is commencing with an attack of croup. There is, 
 however, a great difference between this affection 
 and croup. It is a spasmodic disease, and 
 consists of a closure of the opening into the wind- 
 pipe, by which air is prevented from gaining 
 access to the lungs. It generally occurs during the 
 period of teething, and is unaccompanied by fever 
 or other symptoms of ill-health. The suddenness 
 of the onset, the fact that the child appeared to be 
 in good health when put to bed, the crowing 
 nature of the inspirations and the quickness with 
 which the paroxysm is over, will generally be 
 sufficient to reveal the true nature of the affection. 
 
 What to do in Case of Spurious Croup. 
 
 Put tlie lower parts of tlie body in water at a 
 temperature of about 100*^ P. and pour cold water 
 from a height upon the head. Slapping the chest 
 and buttocks has also a good effect in overcoming 
 the spasm. Should these fail, artificial respiration 
 should be tried. 
 
CEoup, 127 
 
 CEOUP. 
 
 This disease is one of childhood, it generally 
 occurs between the second and fifth year. It docs 
 not begin abrnptly like spurious croup, but ij 
 ushered in by the ordinary symptoms of a cold, such 
 as running at the eyes and nose, feverishness, and 
 slight cough. This part of the disease often fails to 
 give rise to any anxiety, and it is not till the most 
 characteristic symptoms make their appearance 
 that the mother becomes alarmed, and at the same 
 time aware of what is the matter. 
 
 The child generally wakes up in the night with 
 a loud, brassy cough. Inspiration is accomjDanied 
 by a peculiar crowing or whistling sound, there is 
 restlessness and fever, the skin is hot and the pulse 
 quick, and the child cries and moves uneasily from 
 side to side. 
 
 What to do in Case of Ceotip. 
 
 No time must be lost in sending for medical 
 aid, and in the meantime the child should be taken 
 out of bed and put into a warm bath at a tem- 
 perature of 100'' r., and kept in it for half an hour, 
 or a sheet Avrung out of warm water may be wi'aj)ped 
 round the body and blankets on the top, so as to get 
 the skin to act well ; the child should be allowed to 
 
128 CKOtjp. 
 
 remain in this for an hour. And while it is in the 
 bath or the pack, a teaspoonful of ipecacuanha 
 wine should be given every quarter of an hour, with 
 drinks of tepid water between, till the child vomits. 
 
 When taken out of the bath the body should be 
 dried with a warm towel, and sponges wrung out of 
 warm water should be kept constantly applied over 
 the windpipe. If a bronchitis kettle is at hand it 
 shoLild be put on the fire with some water, so as to 
 get the atmosphere moistened by steam passing into 
 the room, or a blanket may be wrung out of hot 
 water and a brick wrapped in it, which answers very 
 well for the same purpose. 
 
SPRAINS. 129 
 
 SPEAINS. 
 
 When the power of movement of a part is 
 weakened as the result of sudden and excessive 
 exertion, it is said to be sprained. The sprain may 
 be slight or severe. If slight, the ligamentous struc- 
 tures surrounding the joint are merely stretched ; if 
 severe, they are lacerated. In the former case, little 
 or nothing may be visible at the seat of injury; in 
 the latter there will be swelling, inability to move 
 the joint without great suffering, tenderness on 
 pressure, and by-and-by there will be a discolor- 
 ation as the result of blood that has been effused 
 from torn vessels at the time of the accident. There 
 is often sickening pain, accompanied by faintness, 
 at the time the injury is received. 
 
 The parts most subject to sprain are the ankle, 
 the wrist, and the thumb. The causes which produce 
 this accident are various : thus, the ankle may be 
 readily sprained by a person slipping his foot upon a 
 loose stone or a j)iece of orange peel. In wrestling 
 and dismounting from the saddle the same thing 
 may happen. Falls from horseback, when the hand 
 is put out to save the body, may give rise to a sprain 
 of the wrist or thumb. 
 
130 SPRAINS. 
 
 What to do in Case of Sprains. 
 
 Sprains are often treated by methods that seem 
 at variance witli one another, and appear to do well 
 with both. Thus some apply cold in the first in- 
 stance, others heat ; usually speaking, warmth will be 
 found more agreeable than cold when applied in such 
 cases, so that the best thing to do in the first in- 
 stance is to foment the part well with warm water, 
 or an infusion of camomile flowers and poppy heads, 
 and keep the part at rest till medical assistance can 
 be procured. These accidents should never be re- 
 garded with indifference, as the usefulness of the 
 joint may be interfered with, and the person's health 
 and capacity for work suffer in consequence. 
 
 When the sprain is not very severe tincture of 
 arnica brushed over the part several times a day will 
 generally suffice to effect a cure. After the more 
 acute symptoms of a severe sprain have subsided the 
 joint should be enveloped in cotton wool, and a good 
 firm bandage applied over this, or an indiarubber 
 bandage, either plain or woven with cotton, which 
 will give a feeling of security to the injured joint, 
 and enable the person to get about much sooner. 
 
 Should pain on movement continue, as it frequently 
 does for some weeks after, the treatment by means 
 of warm applications should be given up and a more 
 tonic or bracing method had recourse to. Tor this 
 
SPRAINS. 131 
 
 purpose the douclie should be employed. A rough 
 and ready bath of this kind may be had by running 
 the tap on the injured pai"t, or pouring water from a 
 height upon it. Then friction, with a rough towel, 
 should be employed for a quarter of an hour or more 
 at a time, and some stimulating application, such as 
 tincture of iodine, applied night and morning. 
 
132 DISLOCATIONS. 
 
 DISLOCATIOl^S. 
 
 By dislocation is meant the separation of the parts 
 of a bone entering into the formation of a joint. It 
 is generally the result of violence, but may be brought 
 about by disease, or even exist from birth : when it is 
 the result of violence the force may be applied either 
 directly, as when a person falls upon the point of his 
 shoulder and dislocates that joint, or indirectly, when 
 falling upon his elbow the same thing happens. 
 
 A dislocation may be partial or complete, the 
 
 former when the surfaces of the bones are in some 
 degree separated, the latter when the action of the 
 muscles comes into play and draws the parts more 
 completely asunder. Simple and compound are also 
 fcerms applied to dislocations, the former, and that 
 more frequently met with, where the skin is un- 
 broken, the latter in which a wound permits of com- 
 munication from the surface with the parts of the 
 bone dislocated. 
 
 Dislocations are more frequent in adult life than 
 at the earlier and later periods, the reason being that 
 in childhood the bones are very yielding, while in 
 old age they are more liable to break on account 
 of their brittleness. 
 
 When a dislocation occurs the following evidences 
 
DISLOCATIONS. 133 
 
 of its existence may be ascertained, viz., an altered 
 appearance of the joint, as compared with the corre- 
 sponding one of the opposite side. Any attempt at 
 movement shows that the natural function of the 
 joint is lost. There is inability to move it in the 
 direction in which movement is usually performed, 
 and each attempt gives rise to pain. After a time 
 swelling occurs, and there may be either lengthening 
 or shortening of the limb, more usually the former. 
 
 What to do in Case op Dislocation. 
 
 It is not often that much can be done by un- 
 skilled hands in the treatment of this accident, and 
 if medical aid can be procured without much delay 
 the person had better just be kept at rest and a 
 surgeon sent for, or he may be conveyed to the doctor's 
 house with as little disturbance as possible. If, 
 however, one is where it is impossible to procm-e 
 help without considerable delay, it may be justifiable 
 to try what, in other circumstances, ought never to 
 be attempted, so that it must be borne in mind that 
 what is said here in regard to treatment, and after- 
 wards in speaking of fractures, is not what is recom- 
 mended if skilled assistance can be had, but rather 
 what may be tried in its absence. 
 
 Surgeons treat dislocations by reducing them, by 
 which is meant the bringing together of the surfaces 
 again as they were previous to the accident. In 
 order to do this it should be remembered that the 
 
134 DISLOCATIONS. 
 
 muscles wliich. formerly kept the bones in tlieir 
 place are now acting powerfully to keep them apart, 
 That which has to be overcome is the influence of 
 the muscles, and in order to do this the employment 
 of traction is necessary. ]^o rough handling of the 
 injured parts must ever be resorted to ; it is not so 
 much strength that is required as method in the 
 right direction of the power that is made use of. All 
 violent tugging and hauling at joints is productive 
 
 Fig. 63.— Clove Hitch. 
 of much mischief and cannot be too strongly con- 
 demned. 
 
 Formerly various methods were resorted to in 
 order to overcome the muscular resistance, such as 
 warm baths, emetics, and tobacco, but these have all 
 given way before the employment of chloroform, which 
 in the surgeon's hands exercises a wotiderful effect in 
 overcoming muscular resistance. Quiet, steady pull- 
 ing is more useful in bringing about fatigue of the 
 muscles than the employment of any amount of 
 mere brute force. 
 
DISLOCATIONS. 135 
 
 The part of the limb nearest the body must be 
 steadied, and an amount of counter extension em- 
 ployed. This may be accomplished by Avrapping a 
 wet bandage or handkerchief round the part and 
 putting over that a skein of worsted, towel, 
 shawl, &c., fastened by means of a clove hitch. One 
 person should seize this while another should pull 
 at the part furthest removed from the body either 
 with his hand or in a m.anner similar to the other, 
 but of course in an opposite direction. 
 
 The thumb may be dislocated from a blow upon 
 
 Fig. C4. — Apparatus employed in the reductiox of Dislocatiox 
 
 OP THE Thumb. 
 
 it, and this accident is generally reduced by pulling 
 upon the part farthest removed from the body, as 
 shown in the diagram, while the part nearest the 
 body is steadied by the disengaged hand of the 
 operator or that of an assistant. 
 
 An awkward accident sometimes happens from 
 the mouth being opened too wide, as in yawning, in 
 which the lower jaw is dislocated. The person 
 remains in a ludicrous plight, his mouth wide open, 
 and he unable to close it. The thumb of each hand, 
 
136 
 
 DISLOCATIONS. 
 
 covered witli a liandkerchief, is placed upon tlie back 
 teeth and the jaw pressed downwards, while the 
 chin is raised and pushed bacl^ by the palms of the 
 hands and fingers. The jaw will generally go into 
 its place with a snap. 
 
 There are several methods made nse of by the 
 surgeon in reducing a dislocation of the shoulder 
 joint. One is to make the person lie down upon his 
 
 Fig. 65. — Eeducing a Dislocation of the Shoulder-joint by means 
 OP THE Heel in the Axilla or Armpit. 
 
 Tlie patient is placed iu the recumbent position uoon the floor, a 
 Gouch, or bed. The surgeon then seats himself beside him, and having 
 taken off his boots, places his foot in the axilla of the dislocated shoulder, 
 making it act as a fulcrum. He then draws the arm steadily downwards, 
 when the reduction will generally be effect ed. 
 
 back, and, putting the heel in the armpit as a counter 
 extending force, the surgeon draws upon the arm 
 either with his hands or in the manner represented 
 in the diagram. Another is to place the knee in the 
 
DISLOCATIONS. 
 
 137 
 
 armpit whilst the foot rests upon the chair in which 
 the patient is sitting-, the arm is then bent over the 
 jcnee, and in this way the dislocated shoulder may 
 be reduced. 
 
 Yet a third method which may be tried by any one 
 
 Fig. 6G.— Rebucing a Dislocation of the Shoulder-joint by the 
 Knee in the Armpit. 
 
 The surgeon is represented as standing by the patient's side with his 
 foot resting upon a chaii', and his knee in the axilla or armpit. His knee 
 thus acts as a fulcruni, and the surgeon, by bending down the arm and 
 bringing it across the knee, endeavours to reduce the dislocation. 
 
 who is unfortunate enough to meet with this accident 
 in the field, is to go to a five-barred gate, and if he 
 has courage to endure some pain, put his arm over 
 
138 
 
 DISLOCATIONS. 
 
 Fig. 67. — Trying to keduce a Dislocated Shouldee. 
 
 tlie topmost rail, and taking liold of tlie lowest lie 
 can reacli, make tlie weight of Ms body tell on the 
 other side, a slight hitch shonld then be given and 
 the head of the bone may be felt to go into its 
 socket. 
 
 In Dislocation of the Hip Joint, where the head 
 of the bone is displaced upwards and backwards, 
 reduction of the dislocation may be effected by 
 bending the leg upon the thigh, and the thigh uj)on 
 the abdomen, then turning it outwards and extend- 
 ing it, the head of the bone may be found to pass 
 
 Fig. 68.— ili'TiioD Emfloyed in the Eeduction of a Dislocation 
 
 OF THE Hip. 
 
DISLOCATIONS. 139 
 
 into its socket. Sometimes the surgeon is obliged 
 to employ an arrangement of pulleys for reducing 
 dislocation of the hip joint as represented in the 
 diagram. 
 
140 FRACTURES. 
 
 JFEACTUEES. 
 
 When a person falls or receiyes a blow wliicli 
 breaks one or more of the bones of the body, a 
 fracture is said to have taken place. Fractures may 
 be either simple or compound. A simple fracture is 
 one in which the skin remains unbroken — a com- 
 pound fracture one in which there is communication 
 between the broken bone and the outer air. 
 
 The compound fracture is a much more serious 
 accident than the simple for this reason, that 
 muscular structures are frequently torn through, 
 and nerves and blood vessels may be lacerated, also 
 that the ends of the bone may come into contact 
 with the ground, and dirt and other foreign sub- 
 stances be in this way introduced into the wound 
 and set up irritation. Antiseptic surgery has done 
 much of late years to render this class of injury less 
 formidable, and many a limb that formerly would 
 have undoubtedly been sacrificed may now be saved. 
 
 There is a third kind of fracture called the 
 green- stick fracture, which, however is more cor- 
 rectly spoken of as a bending or partial breaking of 
 the bones, rather than a fracture. It occurs in 
 children in whom the bones are soft and yielding. 
 
 A fracture may be distinguished from a dis- 
 location in the following way: with one or two 
 
FRACTURES. 141 
 
 exceptions, the fracture is followed by shortening of 
 the limb ; in a dislocation there may be either 
 shortening or lengthening. In a fracture the 
 amount of movement is always greater than natural, 
 in a dislocation it is less. There are pain and 
 swelling in both, but in addition there is that 
 peculiar feeling called crepitus, which is produced 
 on movement by rubbing together the two ends of 
 the bones ; this is never present in a dislocation. 
 
 The signs of fracture may be tabulated as follows : 
 1. Pain accurately localised. 2. Inability to use the 
 limb. 3. Change in shape. 4. Unusual mobility. 
 5. Swelling. 6. Crepitus. 
 
 What to do in Case of Fracture. 
 
 To render first aid when fracture has taken place 
 it must be remembered that the object in view is to 
 bring the ends of the bone that has been broken as 
 nearly as possible to the condition they were in 
 previous to the accident. In order to do this, the 
 part nearest the body must be steadied by some one, 
 while that farthest removed is gently extended or 
 stretched out, and the sound limb should always be 
 uncovered and act as our guide. Then, having got 
 the limb into good position, our next course should 
 be to keep it so, and for this purpose recourse must 
 be had to what are called splints, the object of 
 which is to fix the limb in the position in which it 
 has been placed. 
 
142 
 
 FKACTUKES. 
 
 We cannot always obtain splints such as you will 
 bu}^ at a surgical instrument maker's shop, but for- 
 tunately for ambulance work, this is not necessary 
 as pieces of pasteboard, lath, the covers of books. 
 
 Ftg. 69. — Method of treating Fracture oe the Fibula, or Outer 
 Bone op the Leg, in its Lower Third, known as Pott's Fracture. 
 
 sticks, rulers, hat boxes, stirrup leathers, may all be 
 utilised in this way. Straw or hay wrapped lightly up 
 in towels also answers well. With one or other of 
 these padded with cotton wool, tow, hay, or anything 
 soft, a very good splint may be made, which may be 
 secured in its place by means of towels, hand- 
 kerchiefs^ leather straps, or strips of calico. 
 
 Fig. 70. — Form oe Splint used in the treatment oe Fracture of 
 the Bones of the Leg. 
 
 In simple fractures nothing more should be at- 
 tempted; in compound, some antiseptic dressing, 
 such as carbolic oil on lint or sanitas vaseline, 
 should be laid over the wound. It is not unusual. 
 
FRACTimES. 143 
 
 more particularly in the country, that sprains, dislo- 
 cations, and fractures are treated by persons calling 
 themselves bone-setters. Having had no previous 
 anatomical or surgical training, their treatment of 
 these affections is entirely empirical, and often the 
 surgeon finds, when he is called in afterwards to these 
 cases, that the nature of the injury has been misun- 
 derstood — a joint said to be out that was never dis- 
 
 EiG. 71. — Splints used in the treatment of Feacture of the Shaft 
 
 OF THE RUilEEUS. 
 
 There is an inner short splint, an outer long, and one for the arm. 
 
 located — and the patient has often found to his cost 
 that, owing to the imperfect treatment he has re- 
 ceived, fractures have united badly, and the useful- 
 ness of many a limb has been impaired in this way. 
 
 V/hen a fracture heals it does so by the throwing 
 out of a substance called callus around the seat of 
 the injury, which is soft at first, but in from two to 
 
14 i FRACTURES. 
 
 six weeks unites the bones firmly together. In 
 order that a fracture may heal and leave the limb 
 unimpaired, the broken surfaces must be brought 
 into close contact, and kept in position by means of 
 carefully-applied splints and bandages. The length 
 of time splints are to be kept on will vary with indivi- 
 dual cases, and can only be determined by the medical 
 attendant. 
 
SCALDS AND BUEN3. 145 
 
 SCALDS AND BUENS. 
 
 When a part of the body has its temperature 
 raised tlie effect is to give rise to redness. If the 
 cause is remoyed the redness will quickly pass awaj^, 
 but if it be continued longer the cuticle or scarf 
 skin will separate from the true skin, and a blister 
 will be formed, and if continued longer destruction 
 of the deeper textures will result. Burns and scalds 
 are dangerous according to the part of the body 
 affected, and to the extent of the surface injui^d. 
 
 The condition of health in which the patient is at 
 the time has also much to do with the effect pro- 
 duced, for if a person be in a robust state of body 
 less harm will result than if he is weak and debili- 
 tated. These injuries are generally followed by 
 severe nervous shock, especially when any extent of 
 surface has been affected, and, in consequence, where 
 this happens, although the pain must be exceedingly 
 acute, comparatively little complaint may be made. 
 
 Scalds are produced by hot liquids, such as water, 
 oil, &c., coming in contact with the body. In the 
 case of water that has been boiling, and is upset on 
 the hands or legs, usually speaking some of the heat 
 is lost before it reaches the body, so that the tempe- 
 rature is never really at the boiling point when the 
 water touches the body. In the case of liquids re- 
 
 K 
 
146 SCALDS AND BTJKNS. 
 
 quiring a liiglier boiling point tlian 212° F. (the 
 boiling iDoint of water), the injury is proportionately 
 severer, and the shock greater, and, of course, it is 
 so also if a person falls into any boiling liquid. 
 
 Burns are caused by solid bodies heated to a high 
 temperature coming into contact with the body, or 
 by a jBlame, such as gas or petroleum, gunpowder, 
 &c., and the burn will be severer in proportion to 
 the extent of surface that has been injured, and the 
 length of time, whatever has caused the burn, has 
 been in contact with the body. Molten metal may 
 fall upon a part of the body and roll off it again, 
 producing comparatively little effect, but if it is kept 
 in contact with the body, as, for example, when it 
 falls into the inside of the boot, a very serious injury 
 is produced. 
 
 Many lives are lost through accidents of this 
 sort, and many of those whose lives have been spared 
 have suffered from deformity of one kind or another 
 for the rest of their days. Owing to the carelessness 
 of mothers boxes of matches are frequently left 
 about, and the children, getting hold of the matches 
 and playing with them, set fire to curtains or their 
 night clothes, and are often severely burnt or lose 
 their lives in consequence. Frequently also ladies' 
 dresses are made of such light, combustible material 
 that when, owing to their carelessness, they get into 
 close proximity to the fire, they are speedily enve- 
 loped in a blaze. 
 
SCALDS AND BURNS. 147 
 
 Where light articles of clothing of tins descrip- 
 tion are worn it will be well to remember tbat thej 
 can be rendered proof against such accidents, and 
 that for this purpose all that is required is to soak 
 them in a solution of sulphate of ammonia. Hot 
 liquids should never be placed within the reach of 
 children unless some one is present to look after 
 them, and fires should be so guarded that if the 
 little ones fall there will be no dansfer of their comino^ 
 in contact with the bars of the grate. 
 
 What to do ix case of Scalds axd Buexs. 
 
 "When a person has been scalded the jjart should 
 be at once immersed in cold water, or cold water 
 poured over it, or ice applied if it can be had, or 
 bicarbonate of soda may be dusted over the part and 
 a wet cloth applied on the top of it. When blisters 
 have formed they should be pricked with a needle 
 or pair of scissors, and the cuticle carefully pressed 
 dowQ, after which the bicarbonate of soda may be 
 applied as before, or an ointment composed of five 
 grains of chlorate of potash to the ounce of lard, or 
 Carron oil, which is composed of equal parts of 
 linseed oil and lime water (this compound receives 
 its name from the Carron Ironworks, where it was 
 much used by the men). 
 
 Th3rinol, which is an excellent antiseptic, and 
 
 carbolic oil of the strength of one part to one 
 hundred of olive oil, form useful dressings, and 
 
148 SCALDS AND BTJENS. 
 
 destroy tlie offensive smell which, is apt to be present 
 when the dead tissues separate. Cotton wool forms 
 a useful dressing in cases of scalds and burns ; it 
 should be applied to the injured surface, and a 
 bandage put over it, which renders its action most 
 beneficial. 
 
 When a person's clothes have caught fire it only 
 makes matters worse when she rushes about the 
 room, because currents of air so created fan the 
 flames and increase the blaze. The best thing for a 
 person to do in such a case is to seize some woollen 
 article, such as a rug or blanket, or any other thick 
 m.aterial, and fold it closely round the body, then lie 
 down upon the floor and roll over and over. If there 
 are bystanders present the person should be at once 
 enveloped in the way already described, or coats, 
 shawls, anything handy, may be used to wrap round 
 the body, then cold water should be procured and in 
 large quantities poured over the body. 
 
 When the flames have been extinguished the 
 
 garments should be removed, and of course for this 
 purpose the person must be taken to some convenient 
 place, but she had better not be put to bed in the 
 first instance. All articles of clothing that are in 
 contact with a burnt surface should be cut away; 
 they must on no account be pulled off. After this has 
 been done the burnt surface may be covered over with 
 cotton wool alone, or with some antiseptic dressing, 
 such as thymol, carbolic, or Carron oil underneath. 
 
SCALDS AND BURNS. 149 
 
 The sores that result should be treated with 
 chlorate of potash ointment of the same strength as 
 that previously mentioned, which may be changed 
 once or twice daily. 
 
 The first effect of a severe scald or burn is to 
 
 give rise to great shock to the nervous system, and 
 the pale, collapsed appearance of the patient indi- 
 cates that mild stimulants are necessary. For this a 
 cup of tea may be given, and the diet should be light 
 and nourishing for a few days. The following will 
 answer well :— Milk, eggs, cocoa, mutton broth, 
 beef tea, and the like. When a large surface of the 
 body has been burnt the action of the skin over the 
 part affected ceases, in consequence of which i^reat 
 additional work is thrown upon the external organs, 
 such as the kidneys, which may become congested 
 on this account. The treatment of these affections 
 must of course be left in skilled hands, and for any 
 extensive burn or scald medical aid should be at once 
 sought. It has been recommended by some writers 
 that a rope ladder should be kept in one of the bed- 
 rooms in case of fire breaking out in the house. 
 Tailing this blankets or sheets tied end to end may 
 serve as a means of escape. 
 
 Strong mineral acids produce what is called an 
 eschar when applied to the surface of the body, and 
 have to be treated by the a]3plication of antiseptic 
 dressings, such as thymol, weak carbolic oil, or 
 boracic lint moistened with water. If the slouo-hs 
 
150 SCALDS AND BUENS. 
 
 are difficult of separation, warm antiseptic poultices 
 may be applied, snch as tliose of charcoal. In burns 
 from acids, generally the application of some alkali, 
 such as the bicarbonate of soda, will ease the pain most 
 speedily, and where a person has been burnt by 
 contact with alkaline substances, as in falling into a 
 limekiln, sponging the body with wea,k vinegar and 
 water is often found to be useful. 
 
FKOST BITES. 151 
 
 COLD, CHILBLAINS, FROST BITE, &c. 
 
 By exposure of a part of the body to the influence 
 of cold its vitality is lessened. On the removal of 
 the cold, a corresi^onding reaction sets in, blood 
 flows more freely in the part, and that which was 
 pale, owing to the contraction of the capillaries, 
 becomes red and inflamed-looldng-. Ko harm will 
 resnlt if the cold has not been long in contact with 
 the body, or the duration of the exposure has not 
 been great, where care has been taken that the part 
 numbed by the cold was not brought suddenly into 
 contact with a high temperature, such as holding 
 the part to the fire. When a part of the body has 
 been affected by cold, and reaction has set in, and 
 this has occurred frequently, the surface becomes of 
 a puri^ly colour, and there is itching and swelling, 
 or in other words, what is called a chilblain is 
 developed. 
 
 Chilblains attack those parts of the body in which 
 the circulation is least active, as, for example, the 
 fingers and toes, when they are often very trouble- 
 some during the winter months. Those most liable 
 to this affection are persons who are much exposed 
 to the cold during the frosts of winter, in whom 
 there is a feeble habit of body, or who are exposed 
 to frequent changes of temperature, as in working 
 
152 
 
 FROST EITES. 
 
 amongst cold and hot water alternately. Coming in 
 with the feet cold and numb, and sitting down in 
 front of a bright fire, is very apt to bring on chil- 
 blains. Generally, only the surface of the body is 
 reddened, and there is swelling of the part, but 
 occasionally there may be vesication, blisters may be 
 formed, and disagreeable and troublesome sores may 
 result. 
 
 Treatment of Chilblains. 
 
 When the skin is unbroken, some mild stimulating' 
 application is often beneficial, and for this purpose 
 camphorated oil may be rubbed over the part, or 
 some soap and opium liniment, to which a little 
 tincture of cantharides has been added in the pro- 
 portion of two parts of the latter to six of the 
 former, or tincture of iodine may be painted over 
 with a camel's hair brush or feather nio-ht and 
 
 morning. 
 
 Care slioiild be taken to expose the jjart as little 
 as possible to the action of the air, and warm woollen 
 gloves and stockings should be worn. The person 
 who suffers from chilblains should never come in 
 with hands cold and numb and go to the fire to 
 warm them, but should dip them in cold water, and 
 rub them well till reaction sets in. 
 
 When a sore has been formed some gentle stimu- 
 lating ointment should be applied to the part. For 
 this purpose camphor ointinent, weak iodine oint- 
 
FROST BITES. 153 
 
 ment, iodoform ointment, or one composed of tlie 
 red oxide of mercury, may be used. 
 
 Frost Bites. 
 
 Where the cold has been more intense, or the ex- 
 posure to it greater, frost hite may occur, if it is 
 partial; or the whole body may be frozen. The 
 tendency to suffer from these severe effects of cold is 
 more manifest in country districts than in towns, 
 where people wandering from one place to another 
 are overtaken by snow-storms and overcome by 
 fatigue and cold, sit down under a hedge or wall, 
 and frequently fall asleep. Too frequently, when a 
 person has fallen asleep in this way, death overtakes 
 him, and this is more liable to occur when people 
 have been drinking and have dropped down in an 
 intoxicated condition upon the road. 
 
 The tendency of alcohol is to dilate the small blood- 
 vessels on the surface of the body, and to cause a larger 
 quantity of blood to circulate there, and in proportion 
 as you increase the amount of blood on the surface 
 you take away from the deeper-seated and more 
 vital organs of the body. During sleep the ability 
 to resist cold seems to be much less than when awake, 
 for people are often frozen to death at a temperature 
 less than that in which, in some northern cities, 
 people are enjoying themselves out of doors. A large 
 quantity of blood in the surface capillaries being 
 thrown in upon the deeper structures, owing to the 
 
154 FROST BITES. 
 
 contraction caused by the cold, gives rise to conges- 
 tion of these parts, and if the cold be longer continued 
 the internal structures may become frozen also, the 
 blood in the vessels and the food and liquid in the 
 stomach being converted into ice. 
 
 When a person has "been picked up in a frozen 
 condition he should not at once be removed to a 
 warm room, but may be put into some place where 
 there is no fire. The clothes should then be care- 
 fully removed from the body, as any rough handling 
 may be followed by the breaking of a limb in the 
 rigid condition in which the body is. The whole of 
 the body, or the part that is frozen, should be rubbed 
 with snow, if it can be had, or with cold water if it 
 cannot, or the body may be put into a cold bath. 
 
 If the breathing be stopped artificial respiration 
 should be employed, and if the patient begin to 
 show symptoms of recovery the cold cloths or snow, 
 with which the body has till now been rubbed, should 
 give place to friction with cloths that have been 
 warmed, and the patient may then be removed to a 
 slightly higher temperature. A little tepid fluid 
 may now be given him to drink, such as milk blood- 
 warm, or a little cold tea or cocoa, or beef-tea or 
 mutton broth, and gradually, as the circulation is 
 established, the surroundings of the patient may be 
 made more comfortable. 
 
 Too niucli care cannot, however, "be exercised in 
 
 regard to such cases, and where a person is taken 
 
FKOST BITES. 155 
 
 into a heated atmospliere at once the violence of the 
 reaction, if the whole body has been frozen, will be 
 such as to cause speedy death, and if a part has been 
 frozen mortification will result. 
 
 When any one is exposed to the inflnence of the cold 
 
 he should endeavour to keep up the temperature of 
 the body by active exercise, but if the exposure is 
 long continued, after a time the blood becomes cooled 
 below its natural heat, and then the disposition to 
 sleep becomes great. Everything in one's power 
 should be done to resist this soporific tendency, and 
 we must do all we can to prevent ourselves or others 
 succumbing to its infiuence, because, as has been well 
 said, to sit down is to sleep, and to sleep is to wake 
 no more. 
 
156 DROWNING, 
 
 DEOWNINa. 
 
 When the head is immersed in liquid, or a sub- 
 stance of a gelatinous nature, by whicli the air is 
 prevented from getting to the lungs, death is said to 
 result from drowning. It is not necessary for the 
 whole of the body to be immersed in order that a 
 person may be drowned, and small quantities of fluid 
 have sufficed to bring this about ; as, for example, in 
 the case of a child falling with its face into a basin 
 of water, and being unable to extricate itself, or a 
 person falling down in an epileptic fit, or while 
 drunk in a gutter with his face downwards. Many 
 accidents occur every year from drowning, and it is 
 well for every one to know what is best to be done 
 in such cases, as no one can tell when the moment 
 may arrive for him to render help to some of his 
 fellows. 
 
 Some of these accidents occur in winter during 
 skating, and in all places where this delightful form 
 of exercise is indulged in, an ample supply of ropes 
 and ladders should be provided by the authorities. 
 Tailing these, the bystanders may tie the sleeves of 
 their coats together and throw them out as a kind of 
 rope to the drowning person. 
 
 But by far the greater number of deaths from 
 drowning occur during the summer months, and the 
 frequency of these accidents should impress all with 
 
DROWNING. 157 
 
 the necessity of learning to swim. It may be borne 
 in mind, as Esmarcli has pointed out, that if the 
 hands are kept close down by the sides, and the face 
 held up, that a person, although he cannot swim, 
 will in this way float, but all attempts in the way of 
 shouting for help by raising the hands into the air 
 only increase the tendency of the body to sink. 
 
 What to do in cases of Drowning. 
 
 When a person has been removed from the water 
 
 no attempt should be made to carry him any dis- 
 tance : the work of resuscitation should be begun at 
 once upon the spot, otherwise lives maybe sacrificed. 
 Then the following useful directions in regard to 
 the treatment of the apparently drowned, published 
 by the Royal ISTational Lifeboat Institution, should 
 be put into practice. 
 
 "I. Send immediately for Medical assistance, 
 
 blankets, and dry clothing, but proceed to treat the 
 patient instantly on the spot, in the open air, with 
 the face downward, whether ashore or afloat, ex- 
 posing the face, neck, and chest to the wind, except 
 in severe weather, and removino^ all tio-ht clothino: 
 from the neck and chest, especially the braces. 
 The points to be aimed at are, first and immediately, 
 the restoration of breathiDg; and secondly, after 
 breathing is restored, the promotion of warmth and 
 circulation. 
 
 "II. To restore breathing. To clear the throat. — 
 
158 
 
 DROWNING. 
 
 Place tlie patient on tlie floor or ground with tlie 
 face downward, and one of tlie arms under the fore- 
 head, in which position all fluids will more readily 
 escape by the mouth, and the tongue itself will fall 
 forward, leaving the entrance into the windpipe 
 free. Assist this operation by wiping and cleansing 
 the mouth. If satisfactory breathing commences, 
 use the treatment prescribed below to promote 
 
 Fig. 72.— Dr. Marshall Hall's Method tor the Restoration op 
 THE Apparently Drowned. The Act op Expiration. 
 
 warmth. If there be only slight breathing, or no 
 breathing, or if tbe breathing fail, then turn the 
 patient well and instantly on the side, supporting 
 the head, and excite the nostrils with snuff, harts- 
 horn and smelling salts, or tickle the throat with a 
 feather, &c., if they are at hand. Rub the chest 
 and face warm, and dash cold water, or cold and hot 
 water, alternately on them. • 
 
DROWNING. 
 
 159 
 
 " If there be no success, lose not a momentj but 
 instantly imitate hreathing, 
 
 " To imitate breathing", replace the patient on the 
 face, raising and supporting the chest well on a 
 folded coat or other article of dress. Turn the body 
 very gently on the side and a little beyond, and 
 then briskly on the face, back again, repeating 
 these measures cautiously, efficiently, and per- 
 
 FiG. 73. — Dr. Marshall Hall's Method tor the Eestoratiox op 
 THE Apparently Drowned. The Act of Inspiration. 
 
 severingly, about fifteen times in the minute, 
 or once every four or five seconds, occasionally 
 varying the side. {By placing the patient on the 
 chest, the iveight of the body forces the air out : when 
 turned on the side this pressure is removed and air 
 enters the chest,) On each occasion that the body is 
 replaced on its face, make uniform but efficient 
 pressure with brisk movement on the back between 
 
160 
 
 DROWNIXa, 
 
 and below tlie shoulder-blades, or bones on each 
 side, removing the pressure immediately before 
 turning the body on the side. During the whole 
 of the operations, let one person attend solely to 
 the movements of the head and of the arm placed 
 under it. The result is respiration, or natural 
 breathing, and, if not too late, life. Whilst the 
 above operations are being proceeded with, dry the 
 
 Fig. 74. — BiiEATHiNG Imitated by Dr. Sylvester's Method. 
 Act or Inspiration. 
 
 The 
 
 hands and feet, and as soon as dry blankets or 
 clothing can be procured, strip the body and cover 
 or gradually reclothe it, but take care not to interfere 
 with the efforts to restore breathing. 
 
 *■ III. Should these efforts not prove successful 
 
 in the course of from two to five minutes, proceed to 
 imitate breathing by Dr. Sylvester's method, as 
 follows : Place the head and the hack on a flat surface, 
 
DltOWKINO. 
 
 161 
 
 inclined a little up from fclie feet ; raise and support 
 the head and the shoulders on a small firm cushion 
 or folded article of dress placed under the shoulder 
 blades. Draw forward the patient's tongue and keep 
 it projecting beyond the lips — an elastic band over 
 the tongue and under the chin will answer the 
 purpose, or a piece of string or tape may be tied 
 around them, or by raising the lower jaw the teeth 
 
 Fig. 75. — Bkeaihing Imitated by Dr. Stlvestee's Method. The 
 Act of Expiration. 
 
 may be made to retain the tongue in that position — 
 and remove all tight clothing from about the neck 
 and chest, especially the braces. 
 
 "To imitate the movements of breathing. — 
 
 Standing at the patient's head, grasp the arms just 
 above the elbows, and draw the arms gently and 
 steadily upwards above the head, and lieejp them 
 stretched upwards for two seconds. (By this means 
 
162 DROWNING. 
 
 air is drawn into tlie lungs.) Then turn down the 
 patient's arms, and press them gently and firmly 
 for two seconds against the sides of the chest. (By 
 this means air is pressed out of the lungs.) Eepeat 
 these measures alternately, deliberately, and per- 
 severingly about fifteen times a minute until a spon- 
 taneous effort to respire is perceived, immediately 
 upon which cease to imitate the movements of 
 breathing and proceed to induce circulation and 
 warmth, 
 
 "IV. Treatment after Natural Breathing has 
 been restored. — To promote warmth and circulation 
 commence rubbing the limbs upwards with firm 
 grasping pressure and energy, using handkerchiefs, 
 flannels, &c. (By this measure blood is propelled 
 along the veins towards the heart.) The friction 
 must be continued under the blanket or over the dry 
 clothing. Promote the warmth of the tody by the 
 application of hot flannels or bottles, bladders of hot 
 water, heated bricks, &c., to the pit of the stomach, 
 the armpits, between the thighs, and to the soles of 
 the feet. On the restoration of life a teaspoonful 
 of warm water should be given, and then, if the 
 power of swallowing have returned, small quantities 
 of wine, warm brandy and water, or coffee, should be 
 administered. 
 
 * General ohservations. — The above treatment 
 should be persevered in for some hours, as it is an 
 erroneous opinion that persons are irrecoverable, 
 
DROWNING. 1G3 
 
 because life does not soon make its appearance, 
 persons having been restored after persevering for 
 many hours. 
 
 "Cautions. — Prevent unnecessary crowding of 
 persons round the body, especially if in an apartment. 
 Avoid rough usage, and do not let the body remain 
 on its back unless the tongue is secured. Under no 
 circumstances hold the body up by the feet. On 
 no account place the body in a warm bath unless 
 under medical direction, and even then it should 
 only be employed as a momentary excitant. 
 
 "A method of treating the apparently drowned, 
 
 said to be in many points superior to that just 
 described, has been invented by Dr. Howard, of New 
 York. This '^ direct method,' as Dr. Howard calls 
 it, has two positions. 
 
 "'I, To pump and drain fluid from lungs and 
 stomach. — This is done by placing the patient, face 
 downwards, over a hard roll of clothing, so that the 
 pit of the stomach is the highest point, while the 
 mouth is the lowest. The operator supplements 
 the pressure of his hands upon the back of the 
 patient, above the roll, if necessary, with all the 
 weicfht and force at his command. 
 
 (( t 
 
 II. For artificial "breathing. — The patient, 
 whose clothing is ripped open from the waist, is laid 
 upon his back, and the pit of the stomach is made 
 the highest point by a hard roll of clothing beneath 
 
164 DROWNING. 
 
 tlie back, while the head is the lowest part. The 
 wrists are crossed behind the head ; these a second 
 person, if present, pins to the ground with one hand, 
 while with the other the tongue is held forward by a 
 piece of dry rag.' 
 
 "The greatest possible expansion of the chest 
 is thus obtained. The operator, kneeling astride the 
 patient, grasps the most compressible part of the 
 chest on each side of the pit of the stomach, and 
 using his knees as a pivot throws forward, slowly 
 and steadily, his whole weight until his mouth 
 nearly touches the face of the patient ; then, by a 
 final push, he throws himself back to his first erect 
 kneeling position. 
 
 " By the sudden removal of the compressing force 
 the elastic ribs spring back to their original position, 
 and by this bellows action, the air rushes into and 
 is forced out of the chest alternately, as in natural 
 breathing. Success may attend this process in a 
 few minutes, but hope of a favourable result ought 
 not to be given up under an hour." 
 
 The reason why a person floats, if his arms are 
 kept by his side, as already mentioned, is that he 
 displaces a quantity of water greater in weight than 
 his own body ; that is to say, the specific gravity of 
 his body is less than that of the water in which he 
 is immersed, but, by-and-by, the stomach and lungs 
 become filled with water, and the general specific 
 
DROWNING. 165 
 
 gravity of the body being increased, the body sinks 
 to tlie bottom. 
 
 The length of time during' which a person may he 
 immersed, and yet recover, is uncertain, some say- 
 ing that a body that has been under the water more 
 than four or five minutes can seldom be resuscitated, 
 although cases are reported where recovery has taken 
 place after submersion lasting for fourteen minutes, 
 ■ or even for half an hour. 
 
 In cases of drowning, death may result from the 
 23oisoning of the blood, owing to the oxygen of the 
 air being prevented from getting to it. This is 
 called apncea, or suffocation, and is similar to what 
 takes place in strangling, but death may be caused 
 by syncope, or failure of the heart, or, as in the case 
 of very delicate persons or children, from fright. In 
 others it may be due to apoplexy, as in the aged, or 
 it may be the result of exhaustion, as where a strong 
 muscular person has fallen into the water. 
 
 Ho form of accident happens so easily as drovming 
 in bathing, sailing, inundation, passing over bridges 
 or gangways, in fishing, or among dyers, vraslier- 
 women, tanners, and those engaged about water- 
 works of various Icinds ; while, next to hanging, 
 vountary drowning is the form of death most affected 
 by suicides, particularly in summer. 
 
 The appearance of a hody that has been drowned 
 
 is as foLows : The surface of the body is cold, the 
 
166 DROWNING. 
 
 condition called " goose-skin" is present, the face is 
 pale, there is commonly froth over the mouth, and 
 some gravel and fluid may be found under the finger 
 nails. The lungs are greatly distended, and a bloody 
 froth comes from them when they are cut into. The 
 stomach also generally contains fluid. 
 
EXCESSIVE HEAT. 1G7 
 
 EXCESSIYE HEAT. 
 
 Just as excessive cold acts as a destroyer of life, 
 so does excessive heat, althougli tlie diseases in the 
 one case differ from those of the other. Eermentive 
 changes, the result of decomposition, are Yery apt to 
 occur during the "svarm months of the year, and then 
 diarrhoea becomes j^revalent, which in cities proves a 
 deadly complaint among infants and children. Water 
 supplies are apt to fail, recourse may then be had to 
 that which is of uncertain quality, and typhoid and 
 other fevers be thus brought on. 
 
 Exposure to the direct rays of the sun may give 
 rise to sunstroke. A person may be walking along 
 a road, or be on the hills shooting, and exposed to 
 the influence of great heat, which sometimes results 
 in his feeling giddy and sitting down, or in his drop- 
 ping down suddenly in an unconscious state. In a 
 case of this sort the face will be flushed, and the 
 skin have a pungent, burning feel. The pulse is 
 quick and excited. Breathing is slow, but it has not 
 the snoring character that one finds in cases of 
 apoplexy. Moreover, in the latter disease the sldn 
 is cool. 
 
 The effects of a high temperature may be expe- 
 rienced, however, independently of the direct action 
 of the sun's rays, and many cases of heat strcle occur 
 
1G8 EXCESSIVE HEAT. 
 
 when men are under cover, wlien tliey are crowded 
 together in rooms or tents in which the air stagnates, 
 and where the heat is excessive, or in soldiers on the 
 march, when close together in large numbers. Heat 
 affects some people more injuriously than others, 
 and spirit drinkers are more liable to suffer from 
 sunstroke than others. As in a great many other 
 things, total abstainers in this have a greater immu- 
 nity than those who indulge even in moderation. 
 
 Wi-iAT TO DO IN Case of Sunstroke, &c. 
 
 When any one lias fallen dov/n from sunstroke, or 
 is suffering from the effects of heat, cold water should 
 be at once dashed over his face and head, ice cloths 
 or ice applied, if it can be had, if not, cold water. 
 Give a teaspoonful of spirit of sal- volatile in water, or 
 the same quantity of tincture of cardamoms. Tea or 
 coffee may be given afterwards. As a preventive, 
 when the sun is very powerful, people who are obliged 
 to be out of doors should see that they have some 
 light covering for the head, or have their hats venti- 
 lated, which will keep the head cooler. Some light 
 white material is best, or some green leaves may be 
 put into the hat, or a cabbage-leaf used as a 
 puggaree. Mothers should be careful not to allow 
 children to play out of doors in bright sunshine with 
 the head uncovered. 
 
SUFFOCATION. 169 
 
 SUFFOCATION. 
 
 By suffocation is meant that form of death which 
 results when the atmospheric air cannot reach the 
 lungs so as to oxygenate the blood, and where, in 
 consequence, dark-coloured blood circulates in the 
 body, poisons the nerve centres, and leads to death. 
 It may result from strangulation, as in hanging, from 
 the burning of charcoal in a room from which the 
 air has been excluded, from the accumulation of car- 
 bonic acid gas at the bottom of wells, or in some 
 cellars where new wine and beer are kept, by articles 
 of food sticking in the throat, and so obstructing the 
 entrance of air, by the overlaying of new-born chil- 
 dren ; in short, by anything which cuts off the supj)ly 
 of oxygen to the lungs. 
 
 When the supply of fresh air is cut off from the 
 lungs, the blood immediately begins to be darker in 
 colour, and speedily the brain and nervous centres 
 become poisoned, the body is thrown into convul- 
 sions, but, although these are terrible to the on- 
 lookers, the person probably suffers nothing, and in 
 cases of recovery, after strangulation, there is no 
 recollection of anything occurring at the time. For 
 a while the diaphragm continues to act after the 
 entrance of air to the lungs is stopped, and if the 
 cause that is producing the asphyxia be now removed 
 the patient will speedily recover. 
 
170 SUFFOCATION. 
 
 After tlie diaphragm and intercostal muscles have 
 ceased to act the heart still continues to beat for two 
 or three minutes longer, and the inability to feel the 
 pulse at the wrist must not be taken as an index of 
 the heart having ceased to act, but whenever the 
 heart has stopped beating life becomes extinct, and 
 no amount of effort will be of any avail to resuscitate 
 anv one in such circumstances. The time, then, 
 during which any one can be of service, either in 
 cases of hanging, choking, or the accidents giving 
 rise to suffocation, is very limited indeed, and what 
 is to be done must be done at once. 
 
 What to do in Case of Suffocation. 
 
 If a person is found hanged he should be at once 
 cut down, but care must be taken to support the 
 body, and not allow it to fall with its weight upon 
 the ground. Artificial respiration should be at once 
 resorted to, and if fortunate enough to have natural 
 breathing restored we must still remember that the 
 patient is in a very critical state, and that he may 
 remain in an insensible condition, similar to that 
 produced by narcotic poisoning, and die some hours 
 afterwards. It makes the greatest difference in these 
 cases, whether the breathing has stopped or not, if it 
 has not there is generally little difficulty about re- 
 suscitation, but if ifc has, the difficulty of restoring 
 the patient to health is very great. 
 
 If the suffocation results from articles of food 
 
SUFFOCATION. 171 
 
 remaining blocked in tlie throat the treatment re- 
 commended before should be at once adopted. 
 
 If a person is suffocated bj the breathing* of coal- 
 gas, sewer gas, or by being in a room where charcoal 
 has been burnt, the first thing, of course, to do is to 
 get the patient out as speedily as possible, but for 
 this purpose care must be exercised, on the part of 
 the person rescuing, that he does not succumb to the 
 influence of the poison. A lighted candle should be 
 carried in the hand, and wherever the light shows 
 symptoms of failing, it is high time for the person to 
 be getting out. In going down pits, wells, and the 
 like, the person should be carefully roped round the 
 shoulders and waist, and carry a signal cord in his 
 hand, and whenever there is any failure in the sis"- 
 nalling he must be at once drawn up. Quantities 
 of lime thrown into wells will often oret rid of 
 poisonous gas, or disturbing the air by the openino- 
 and closing of an umbrella will cause the air to 
 circulate, and so render it more fit for respiration. 
 Of course, in all these accidents, no time should be 
 lost in sending for medical aid. 
 
172 roisoNs. 
 
 POISOISTS. 
 
 Poisons are substances which, when introduced 
 into the system, are fitted to injure health. Many 
 poisons, as such, when administered by a skilled 
 hand, and in medicinal doses, prove exceedingly 
 useful in the treatment of disease, so that the quan- 
 tity taken or given, and the condition of the patient's 
 stomach at the time, have to do with determining 
 whether the amount that has been introduced into 
 the system will prove dangerous or the reverse. 
 
 Broadly speaking, we have two sets of poisons to 
 
 distinguish — viz., those which act as irritants and 
 those which act as narcotics. Among the former 
 class of substances are sulphuric acid, or oil of 
 vitriol, oxalic acid, phosphorus, arsenic, alkalies, 
 such as soda, lime, and caustic potash, and among the 
 latter, opium, chloral, prussic acid, alcohol, bella- 
 donna, foxglove, tobacco. 
 
 The irritant poisons give rise to burning and 
 violent pains in the stomach, and over the whole 
 abdomen. They cause vomiting and purging, there 
 is coldness of the skin, cold perspiration, quickened 
 and depressed pulse, tenderness on pressure over the 
 stomach and bowels. 
 
 Narcotic poisons give rise to congestion of the 
 brain, lungs, heart, and spinal marrow, producing 
 
POISONS. 173 
 
 torpor, delirium, insensibility, slow, irregular breath- 
 ing, and in some instances dilatation, in others con- 
 traction of the pupils. Some poisons act upon the 
 central organs, paralysing them and poisoning the 
 blood. In these cases death is either instantaneous, 
 or preceded by paralysis or spasm, as, for example, 
 prussic acid and chloroform. Other poisons give rise 
 to wasting of the body and ruining the health. In 
 this category are lead and mercury. 
 
 What to do in case of Poisoning. 
 
 In the treatment of a case of poisoning we must 
 act promptly in whatever is to be done, and the first 
 thing to do is to try and remove the poison from the 
 system ; failing this, to endeavour to counteract its 
 injurious effects. Many of the irritant poisons, by 
 giving rise to vomiting, are got rid of without the 
 need arising: for the administration of emetics, or 
 the use of the stomach pump. In such cases vomit- 
 ing should be encouraged by the giving of draughts 
 of tepid water, and the injurious effects may thus be 
 prevented. 
 
 "V7hen, however, vomiting does not occur naturally 
 
 as a result of what has been taken into the stomach, 
 it becomes necessary either to give emetics or use 
 the stomach pump. This instrument is composed of 
 a syringe or pumping apparatus, and a piece of 
 elastic tubing attached to it sufficiently long to reach 
 the stomach. The elastic tube, in using this instru- 
 
174 POISONS. 
 
 ment, lias to be carefully passed into tlie stomacli, 
 and when there, tepid water should first of all be 
 injected into it. Then the syringe is filled by draw- 
 ing out the handle, and by closing the stop-cock the 
 fluid passes away by the smaller tube, Avhen the pro- 
 cess is again repeated. This should be done till the 
 
 Ftg. 76. — Instrument used in place of the Stomach Pump to 
 Evacuate the Contents of the Stomach in cases of Poisoning. 
 
 fluid coming away is clear and free from all smell of 
 the poison. This instrument is not so much used 
 now as formerly, but is at times found extremely 
 useful. The passing of the tube, and the manage- 
 ment of the stomach pump generally, can hardly be 
 undertaken by any unprofessional person. Should 
 
roisoxs. 17o 
 
 it, however, bo at liand, and any one be found who 
 will use it, the utmost care must be taken to pass 
 the tube along the hack of the throat, and the greatest 
 gentleness must be observed in its introduction. Be 
 sure to keep to the hach of the throat, otherwise the 
 tube may find its way into the windpipe instead of 
 the oesophagus. 
 
 In case of irritant poisoning", it must be borne in 
 mind that the tissues are generally softened, and if 
 anything like force is used, the tube may be pushed 
 through the walls either of the stomach or the 
 oesophagus. 
 
 An easier instrument to use than the stomach 
 pump, and one which answers very well, is made of 
 a piece of elastic tubing ' about a yard and a half 
 long, with a funnel attached to one end. The end 
 furthest removed from the funnel is inserted into the 
 back of the person's mouth, and, if not unconscious, 
 he is to be asked to make efforts to swallow it. By 
 this means it will be got into the stomach, and then 
 the end with the funnel attached to it is to be raised 
 above the head, and as much water poured down as 
 the stomach can contain, then by lowering the funnel 
 below the line of the stomach the stomach will emjDty 
 itself, and by continuing the sy^^hon process of filling 
 and emptying the poison will be got rid of. 
 
 Emetics. 
 In every case of poisoning an effort should be 
 
176 POISONS. 
 
 made in tlie first instance to excite vomiting, and in 
 many cases tlie attempt will succeed. For this pur- 
 pose a handful of salt may be mixed with, some luke- 
 warm water, and this given to the patient to drink, 
 and draughts of tepid water should be given after- 
 wards. Mustard is a capital emetic where the poison 
 taken is not of the irritant order. The dose is a 
 tablespoonful in tepid water, to be followed by tepid 
 drinks. 
 
 Ipecacuanha, either in powder or as wine, is also 
 most useful, especially when the poison is of the 
 irritant class. Twenty grains of the former, or a 
 tablespoonful of the latter, may be given to an adult, 
 and lukewarm water administered as before. Smell- 
 ing salts prove useful as an emetic in some cases, 
 and it should be borne in mind that vomiting can be 
 greatly assisted by tickling the throat with a feather 
 or the finger. Perhaps one of the most useful of all 
 the emetics is sulphate of zinc. It should be given 
 in twenty grain doses, and may be administered in 
 all cases where the poison taken is not an irritant. 
 
 Before speaking of particular poisons there are 
 some general facts that ought to be kept in mind, 
 such as that alkalies and acids are antagonistic to 
 one another, so that, when the former is the poison 
 that has been taken, weak vinegar may be given, or 
 the latter, chalk and water, whiting, plaster from the 
 walls, &c. When an irritant poison has been taken, 
 give some fluid substance like white of egg or milk. 
 
POISONS. 177 
 
 and, if the poison be laudanum, or any other of 
 the narcotic order, strong coifee should be at once 
 administered, and every effort made to keep the per- 
 son awake. 
 
 Irritants 
 
 Arsenic. — Most cases of poisoning occurring in 
 this class are .due to arsenic. This substance is used 
 in the manufacture of certain green colours, as seen 
 in wall-papers and calicoes. It is also employed by 
 farmers for the destruction of vermin, and as a wash 
 for sheep. 
 
 Symptoms. — These are excessive thirst and dryness 
 of the throat, burning pain in the stomach and 
 bowels, severe vomiting and purging, both evacua- 
 tions being bloody, suffusion of the eyes. The 
 breathing then becomes difficult, the pulse is small, 
 hard, and quick, the thirst is incessant. The ex- 
 tremities become cold, and death is usually preceded 
 by convulsions. There is no antidote. 
 
 Treatment. — Give large quantities of sugar and 
 water, or linseed tea, so as to promote vomiting and 
 protect the coats of the stomach. When the violent 
 symptoms are subdued, broth and other light diet 
 may be given, but this will be subject to the medical 
 attendant. 
 
 Corrosive sublimate, or bichloride of mercnry. — 
 
 This substance is used by taxidermists to preserve 
 the skins of animals and birds. 
 
178 POISONS. 
 
 Symptoms. — A strong metallic taste in the mouth, 
 a choking sensation in the throat, and a hot 
 burning feeling extending along the mucous surface 
 from the mouth to the stomach. There is nausea 
 and vomiting, also severe purging, the evacuations 
 being mixed with mucous and blood. There is 
 great nervous depression, the pulse is feeble, quick, 
 and irregular, the tongue has a white shrivelled look. 
 The surface of the body is cold and clammy. Con- 
 vulsions or stupor may then set in, and the person 
 may die. 
 
 Treatment. — The antidote for this poison is white 
 of egg, which ought to be beaten up with water, and 
 repeated at intervals, so as to favour vomiting. Milk 
 or sugar and water in large quantity may be given 
 if eggs cannot be had. Should vomiting not have 
 been produced by the medicine, or by the antidote, 
 the throat should be tickled, and ipecacuanha or salt 
 and water given as an emetic. 
 
 Phosphorus. — This substance is found in two 
 forms, one yellow and the other red — the former is 
 poisonous, the latter is not. It is this which enters 
 into the composition- of various pastes for killing 
 rats, and is used in the manufacture of lucifer 
 matches. Children have been poisoned by sucking 
 the heads of these matches, and adults by taking one 
 or other of the pastes already referred to, either 
 accidentally or with the intention of committing 
 suicide. 
 
POISONS. 179 
 
 Symptoms. — The effects produced when this poison 
 has been taken are violent, and burning pain over 
 the stomach and belly, frequent eructations of gas, 
 smelling of garlic, the vomited matter having the 
 same smell, and being possessed of the property of 
 shining in the dark. There is great anxiety and 
 restlessness, the pulse is small, and scarcely to be 
 felt. There is cold perspiration, subsequently pecu- 
 liar prostration, which may or may not be followed 
 by convulsions, then death. 
 
 Treatment. — Give an emetic, preferably twenty 
 grains of sulphate of zinc dissoh^ed in water. Then 
 give lime-water, charcoal, demulcent, mucilaginous, 
 or albuminous drinks, such as barley-water, linseed- 
 tea, gum-Avater, or white of egg and water, afterwards 
 gentle laxatives may be given. Oil of turpentine 
 has been used as an antidote with success, it pre- 
 vents the oxidation of the phosphorus, and renders 
 it inert. 
 
 Lead. — The preparations of lead which are apt to 
 give rise to poisoning are the carbonate or Avhite 
 lead, and the acetate or sugar of lead, as it is called. 
 The former generally proves injurious to the system 
 in the case of those who work amongst it and are 
 exposed to its fumes, such as painters, plumbers, and 
 the manufacturers of it. 
 
 Symptoms. — When taken into the s^^stem in large 
 doses, or in the form of sugar of lead, as by the 
 drinking of wines that have been clarified by its 
 
180 POISONS. 
 
 addition to tliem, or as Goulard's Lotion, wHch. is a 
 solution of the acetate of lead, it gives rise to sick- 
 ness and vomiting, accompanied by violent pains in 
 the stomach and bowels. There is a metallic taste in 
 the mouth, with dryness of the throat, and thirst. 
 
 When the system is exposed to the iufluence of the 
 fumes, or when it is imbibed through the pores of 
 the skin, a peculiar train of symptoms arises — viz., 
 a blue line on the gums, obstinate constipation, colic, 
 and a peculiar form of paralysis of the muscles, 
 which raise the back of the hand, giving rise to the 
 affection known as drojp wrist. If the action of the 
 poison continues, the paralysis extends to other 
 muscles of the body than those just mentioned. The 
 colic, which arises from lead poisoning, has little to 
 distinguish it from ordinary colic, the pain is per- 
 haps more persistent and intense in character. 
 
 Treatment. — When poisoning has arisen from a 
 single overdose of lead in any of the forms already 
 indicated, give an emetic or employ the stomach 
 syphon, after which purgatives, such as Epsom or 
 Glauber's salts, should be administered in doses oi 
 two teaspoonfuls every two hours till the bowels act. 
 When this has been accomplished, the salts should 
 be continued in less quantity, along with dilute 
 sulphuric acid, after which large doses of iodide of 
 potassium (10 grs. or so) should be administered to 
 eliminate the poison from the system. 
 
 Bar3rtes, or the oxide of Barium, is exceedingly 
 
POISONS. 18] 
 
 poisonous, and, when taken into tlie system, gives 
 rise to burning in tlie stoinacli, vomiting, griping, 
 purging, paralysis, convulsions, and death. 
 
 Treatment. — The antidote for this poison is Epsom 
 or Glauber's salts, which forms an insoluble sulphate, 
 and passes away in the motions. 
 
 Oxalic acid, or acid of sugar, is sometimes mis- 
 taken for Epsom salts, to which it bears a consider- 
 able resemblance. Half an ounce of this substance 
 will prove rapidly fatal, but a much less quantity will 
 destroy life. 
 
 Symptoms. — After taking this poison there is a 
 burning sensation in the throat and stomach, often 
 bloody vomiting, extreme general debility, almost 
 amounting to paralysis, very feeble, and often im- 
 perceptible pulse. When a large dose has been taken, 
 death may occur in a few minutes, and it is very 
 seldom that the fatal issue is delayed beyond an hour. 
 In some cases there is numbness down the back, and 
 in the lower extremities ; in others, very acute pain. 
 in the same parts. 
 
 Treatment. — The antidotes to this poison are mag- 
 nesia and chalk, one or other of which should be given 
 as speedily as possible. They form, with the oxalic 
 acid, msoluble and harmless salts ; one of them should 
 be mixed with just sufficient water to render it drink- 
 able, and a mouthful may be given every two or 
 three minutes, till two or three ounces have been 
 
182' POISONS. 
 
 swallowed. Do not trouble about giving emetics in 
 these cases, as valuable time may be lost. Of course, 
 if possible, medical assistance should be got at once. 
 A stomach, syphon should not be used until the anti- 
 dote seems to fail. 
 
 Copper. — There are several ways in which this 
 substance may become poisonous, althouc^h in its 
 metallic state it is inert. The most usual method of 
 poisoning by copper results from carelessness in the 
 use of vessels made of this metal, these being used 
 when not properly tinned, and acid or greasy sub- 
 stances allowed to remain in contact, which form the 
 acetate of copper, or verdigris, with which all are 
 familiar. This getting into the food, poisons the 
 individual, and gives rise to the following symptoms : 
 
 Symptoms. — If the quantity taken be small in 
 amount, there will be pain in the stomach, accom- 
 panied by sickness and vomiting. The vomited 
 matters have frequently a coppery taste, and are bitter. 
 Sometimes they are greenish or bluish. Should the 
 person who has been poisoned by this substance be 
 in a feeble state of bodily health, as, for instance, 
 suffering from dysentery, or the quantity taken be 
 large in amount, all the previous symptoms are 
 aggravated, and are followed by bloody stools, cramps, 
 convulsions, and death. 
 
 Treatment. — The most handy thing to give by way 
 of treatment in cases of poisoning from any of these 
 preparations is w^hite of egg, which should be admin- 
 
POISONS. 183 
 
 istered at once. If medical aid can be had, the 
 stomach pump will generally be resorted to in the 
 first instance, and white of egg given afterwards. 
 Later on give, in addition to the white of egg, 
 enemata to act upon the bowels, so as to get rid of 
 any of the poison that may lodge in the lower 
 bowel. 
 
 Bine vitrol, or the sulphate of copper, occasionally 
 gives rise to poisoning, but generally it is rejected, 
 owing to its emetic properties. The symptoms and 
 treatment are similar to those spoken of above. 
 
 Corrosives. 
 
 Sulphuric acid, or oil of vitriol, is sometimes used 
 as a poison in children, and adults in an unconscious 
 state, also it may be taken accidentally, as, for 
 example, when, owing to its oily nature, it has 
 been taken in mistake for castor oil. 
 
 Symptoms. — The effect of this poison on the mucous 
 membrane of the tongue and cheeks is to cause 
 whitening, owing to the destructive effect it exercises 
 upon it. Immediately after it is taken there is 
 violent burning pain in the mouth, throat, and 
 stomach, accompanied by a feeling of constriction, 
 burning thirst, vomiting of blood. Should the dose 
 be considerable, death takes place very quickly. 
 
 Treatment. — The antidotes for this poison are 
 alkaline bicarbonates, and carbonates, such as soda 
 
184 POISONS. 
 
 and potasli. Chalk or magnesia may be nsed in the 
 absence of these others. Mild diluents, such as olive 
 or almond oil, should also be given. Both the stomach 
 pump and stomach syphon had better be avoided, 
 miless used by the medical attendant. Afterwards, 
 should the patient recover from the first effects of 
 the poison, the treatment necessary for inflammation 
 of the parts must be had recourse to. 
 
 Nitric acid, or aquafortis, and hydrochloric acid, or 
 spirit of salt, are other examples of corrosive poisons. 
 In the symptoms to which they give rise, and the 
 treatment to be adopted, there is nothing to be added 
 to what has already been said under sulphuric acid. 
 
 Carbolic acid. — This substance, from the frequency 
 with which it is used as a disinfectant and antiseptic, 
 occasionally gives rise to poisoning. 
 
 Symptoms. — It has a strong local irritating and 
 hardening effect, causing whitening of the mouth 
 and skin, burning pain in the throat and stomach is 
 complained of, which is succeeded by rapid collapse 
 and insensibility. 
 
 Treatment. — Use the stomach syphon if it is at 
 hand, then give large quantities of olive oil or melted 
 butter. 
 
 Alkalies. 
 
 Under this head are included potash, soda, and 
 ammonia. The first of these may be met with either 
 as caustic potash, as carbonate, or in the form of 
 
POISOXS. 
 
 185 
 
 pearl aslies and soap lees; the second as caustic 
 soda, carbonate or common washing soda, and soap 
 lees. Ammonia may give rise to poisoning, either in 
 the form of vapour in solution or in the solid form. 
 
 Symptoms. — Poisoning from any of these sub- 
 stances gives rise to a sensation of burning in the 
 mouth and throat, extending to the stomach, purging, 
 and a cold clammy condition of the surface of the 
 body. 
 
 Treatment. — Give drinks containing vinegar or 
 lemon juice, and oils, such as olive or salad oil. 
 
 Naecotics. 
 
 Preparations of opium taken in poisonous doses 
 frequently call for " first aid," and by far the most 
 usual is 
 
 Laudanum, so that we may consider the symptoms 
 produced by these poisons by studying the effect of 
 an overdose of this drug. It is frequently resorted 
 to by suicides, and being often found in houses where 
 it is kept for medicinal purposes, it is frequently 
 taken by mistake. Many of the patent medicines 
 advertised as soothing syrups, and which are often 
 ignorantly given to children by mothers^ owe their 
 influence to the presence of opium. 
 
 Symptoms. — When an overdose has been taken it 
 is followed by drowsiness, stupor, and an uncon- 
 trollable desire to sleep. If the quantity taken be 
 
186 POISONS. 
 
 sufficient to prove fatal, and nothing is done to 
 counteract its effects, tlie stupor becomes deeper, no 
 efforts can arouse to consciousness, there is vomiting ; 
 violent contortions and convulsions are the harbingers 
 of death. 
 
 Treatment. — As there is no antidote to this poison, 
 it must be borne ui mind that the first thing to be 
 done is to get rid of what is in the stomach by means 
 of emetics. For this purpose sulphate of zinc in 
 twenty grain doses may be given, followed by draughts 
 of lukewarm water, or mustard and water, or salt and 
 water, or twenty grains of ipecacuanha powder; 
 tickle the throat with a feather or the finger. K 
 vomiting cannot be brought about, and a stomach 
 syphon be at hand, it should be used, and the 
 patient, as soon as the stomach has been emi^tied of 
 its contents, should be given strong coffee, and the 
 drowsiness which oppresses the patient must be com- 
 bated by constant movement, especially out of doors. 
 Get him out into the fresh air if he can walk, and 
 drag him about till the sleepy feeling passes away. 
 Stimulating enemata, such as turpentine and castor 
 oil, may be given to rouse him further, and get rid 
 of any of the poison that may have reached the 
 lower bowel. Lemonade, or vinegar and water, should 
 be administered at intervals. 
 
 Belladonna. — The berries of the deadly nightshade, 
 as belladonna is more popularly called, have fre- 
 quently proved poisonous in the case of children 
 
POISONS. 187 
 
 who, attracted by tlieir beautiful black colour, liave 
 gathered and eaten them. 
 
 Symptoms. — They give rise to nervous tremors and 
 symptoms resembling intoxication, as well as vomit- 
 ing and griping. This substance has a peculiar 
 effect on the pupil of the eye, causing it to become 
 very greatly dilated. If the quantity eaten (and for 
 this purpose only a few beiTies are required) gives 
 rise to the above symptoms, they are speedily followed 
 by convulsions and death. 
 
 Treatment. — The treatment consists in the imme- 
 diate administration of an emetic, such as mustard and 
 water, sulphate of zinc, or anything that is handy ; 
 the use of the stomach syphon, after which a sharp 
 purge should be given, and repeated doses of vinegar. 
 Hot bottles may be placed to the feet. Strong coffee 
 Qiay be given. 
 
 Henbane, thorn apple, and tobacco give rise to 
 similar symptoms, and the treatment is the same. 
 
 Pnissic acid may be in the form of cherry-laurel 
 water, cyanide of potassium, which is used by photo- 
 o-raphers, and essential oil of bitter almonds, that 
 has not been freed from this poison. Death ensues 
 very rapidly, almost instantaneously, when a poisonous 
 dose has been talien. 
 
 Treatment. — The only thing that can be done in 
 cases of this sort, when a person is in time to do any- 
 thino", is to dash cold water from a height upon the 
 
188 POISONS. 
 
 liead and shoulders, apply smelling salts to tlie 
 nostrils, and employ artificial respiration. 
 
 Shell-Fish, 
 
 Such, as mussels, may give rise to poisonous 
 symptoms. These are sickness, giddiness, swelling of 
 the face, and an eruption upon the skin like nettle- 
 rash. More violent symptoms occasionally arise, 
 such as pain in the stomach and bowels, convulsions, 
 and even death. 
 
 Treatment. — This consists in the giving of an 
 emetic, then a purgative, and twenty or thirty drops 
 of ether on a lump of sugar. Should the symptoms 
 not pass away by these means, give ten or fifteen 
 drops of laudanum in a little water. 
 
 Poisonous Fungi. 
 
 A considerable amount of doubt exists in the 
 
 popular mind as to which mushrooms may be eaten 
 with impunity, and which are poisonous. Only those 
 mushrooms should be eaten which grow in airy 
 places, whose colour is white or brownish, which do 
 not change colour on a cut surface being exposed to 
 the air, and whose taste is not bitter or astringent. 
 On the other hand, mushrooms of bright gaudy 
 colour clustering around the roots of trees, with 
 soft watery flesh, astringent taste, and whose cut 
 surface becomes blue on exposure to the air, should 
 be avoided. 
 
POISON'S. 189 
 
 Symptoms. — The symptoms are those of irritant 
 and narcotic poisoning. There is vomiting and 
 purgmg, abdominal pain, followed by convulsions. 
 
 Treatment. — Give an emetic of mustard and water 
 in the first place, and a dose of castor oil after- 
 wards. 
 
 Other Poisons not Classified. 
 
 Foxglove, or digitalis, is found growing wild in the 
 woods and hedgerows over the greater part of the 
 country. It may be plucked and eaten by children, 
 when it will give rise to the following symptoms : — 
 
 Symptoms. — Nausea, vomiting and purging, abdo- 
 minal pain, pain in the head, giddiness, and loss of 
 sight, delirium, and insensibihty. 
 
 Treatment. — Give an emetic, which should be 
 followed by a purgative, strong coffee or tea may 
 also may be given. 
 
 Hemlock. — Cases of poisoning sometimes occur 
 from this plant being eaten in mistake for parsley. 
 It may be known by its smooth spotted stem, and by 
 the mousey odour which is given off from every part 
 of the plant. 
 
 Symptoms. — It gives rise to dryness ot the throat, 
 drowsiness, dilatation of the pupil, staggering gait 
 and loss of power in the limbs. 
 
 Treatment. — Emetics, castor oil, strong tea. 
 
190 POISONS. 
 
 Laburnum. — The seeds of this well-known tree are 
 sometimes eaten bj children, and give rise to vomit- 
 ing, foaming at the mouth, convulsive movements of 
 the body, and insensibility. 
 
 Treatment. — Give an emetic of mustard and water, 
 and five or ten drops of spirit of sal-volatile in a 
 little water. 
 
 Aconite, monk'sliood, or "blue rocket, is sometimes 
 taken by mistake for horse-radish. It gives rise to 
 dryness of the throat, accompanied by tingling and 
 numbness. The numbness and tinghng gradually 
 extend over the rest of the body. There is loss of 
 muscular power, staggering gait, giddiness. The 
 pulse becomes weak and irregular, the skin cold and 
 clammy. 
 
 Treatment. — Give an emetic of mustard and water, 
 or sulphate of zinc, then castor oil. Hot bottles 
 should be apphed to the feet, stimulants vriU be, 
 required, such as aromatic spirits of ammonia or 
 strong coffee. 
 
TltANSPORT. 
 
 191 
 
 TEA:NrSPOET. 
 
 When a person is wounded or injured in any way, 
 so as to render liim wholly incapcable of making any 
 exertion for himself, or only able to do so partially, 
 it becomes necessary for those who may be called 
 upon to render " first aid" to devise some means by 
 
 Fig. 77. — Stretchee on Wheels used in the Teansport of the 
 
 Injured. 
 
 which the patient may be removed, either to the 
 surgeon or to the nearest house, till surgical aid can 
 be procured. 
 
 For this purpose some form of stretcher is used 
 when the injured can render no assistance for him- 
 self, or help may be given him in a variety of ways 
 when he is in some degree able to assist himself. A 
 great variety of stretchers may be had, from the mora 
 
192 
 
 TEANSPOET. 
 
 elaborate on wheels to one extemporised on a country 
 road, from tlie materials that are to hand, but in all 
 the principle is the same, and consists in providing a 
 surface on which the wounded or injured person may 
 be laid and conveyed with the least possible disturb- 
 ance by bearers to the place to which it is intended 
 to carry him. Two poles, with a piece of canvas 
 stretched between them, constitute the more usual 
 form of stretcher, the ends of the pole are used to 
 carry the patient by, and are either taken hold of by 
 
 Fig. 78.— Simple tobm op Stretchfr used in the Transpokt of ths 
 Injured, consisting or a piece of strong canvas stretched 
 
 BETWEEN TWO POLES. 
 
 the hands of the bearers and carried thus, or straps 
 are brought over the shoulders and fixed to the poles, 
 so that the weight is borne in this manner. 
 
 Instead of made poles and canvas— stretchers ready 
 to hand— we may have to make something on the 
 spot. When this is the case, we must look about us, 
 and for this purpose we may make use of branches of 
 trees, with sacks, blankets, rugs, plaids, or coats 
 stretched across for the person to lie upon. Should 
 
TRANSPORT. 193 
 
 an accident requiring the use of a stretclier occur on 
 a moor while shooting, or on the battle-field, guns 
 may be made use of as poles of the stretcher, stuck 
 throucrh the sleeves of coats that have been turned 
 outside in, and the coat made to button over them. 
 
 In tlie absence of anything that will answer for 
 poles, a rug, blanket, or shutter may be used, carried 
 by four men having a corner apiece. A shutter is 
 often very convenient in street accidents as a means 
 of transport, and can generally be easily procured. 
 Something soft should be placed upon it if possible. 
 
 It would be well if every place where there is risk 
 
 of accidents occurring were provided with a stretcher, 
 so that no time might be lost in conveying the injured 
 to hospital or elsewhere. All police stations should 
 be provided with them, so that when people want 
 them they would know where to get them, and valu- 
 able time be thus saved. Suppose, then, that the 
 stretcher is provided, the next thing to do is to get 
 the patient upon it. 
 
 For this purpose one end should be placed close to 
 the head, not alongside the wounded man, but behind 
 him, and in a line mth the body, the head being in 
 the centre. Then two men should place their hands 
 under the back and upper part of the patient's 
 thighs, and a third take charge of the head, and he 
 be gently lifted back upon the stretcher. This accom- 
 plished, the body should then be raised from the 
 ground by means of the ends, handles, or whatever we 
 
194 
 
 TRANSPORT. 
 
 have ; the third j)erson takes his stand by the head 
 at the side, and now all is ready to start. But here 
 care must be exercised, for it won't do to start off just 
 anyhow, a definite idea must be in the mind as to 
 how to proceed. 
 
 Fig. 79.— a Method of Conveying the Injured when the Patient 
 Himself is Capable of Rendering sojie Assistance. 
 
 The step should be broken, that is the right foot of 
 one bearer should touch the ground simultaneously 
 with the left foot of the other bearer, and so on. 
 This makes transport much more easy, because it is 
 free from that unevenness which attends movement of 
 this sort when done in step, as in marching. On 
 
TRANSPORT. 
 
 195 
 
 going up liill the patient's head should be before, on 
 going down hill behind, unless in leg injuries, when 
 
 Fig. 80.— Sedan Chair used in the Transport of the Injured. 
 
 this may be found hurtful from the weight of the 
 body pressing on the part. The third man must 
 look after the head, and relieve one or other bearer 
 when tired. 
 
 Fig. 81. — Method or Rfnderinq Assistance when the Patient 
 IS able to Walk. 
 
190 TRANSPORT. 
 
 Should the patient be himself able to render assist- 
 ance, the liands of the bearers may be placed under 
 the loins and thighs aiid joined, and the patient's 
 arms be put round the bearers' necks, or a Sedan 
 chair may be formed in the way so well-known — viz., 
 by grasping one's own forearm with one hand, and 
 the forearm of another person with the disengaged 
 hand, he doing the same. In this way patients may 
 be carried some distance. 
 
 If the patient can walk, his arm may be placed 
 round the neck of another, and the one hand of the 
 person who is rendering assistance be placed round 
 the waist of the injured person, while at the same 
 time he takes hold of the hand that is round his 
 neck. 
 
BANDAGING. 197 
 
 BANDAGING. 
 
 It is necessary for those who are called upon to 
 render " first aid" to know how to apply a bandage to 
 different parts of the body. But as this can only be 
 learned practically, the chapter treating of this 
 subject will be largely illustrative, so as to enable the 
 reader, by reference to the diagrams, to familiarise 
 himself with the methods employed, and by prac- 
 tising upon some one else to obtain a knowledge of 
 this important branch of ambulance work. 
 
 Bandages are, generally speaking, used to give rest 
 and support to the part to which they are applied, 
 to keep on dressings of various kinds where there are 
 wounds or ulcers, and to diminish swelling:. 
 
 Special "bandages are frequently employed, such as 
 Dr. Martin's rubber bandages, which are usefal in 
 ulcers of the legs, and where there is swelling due to 
 the presence of fluid in the cellular tissue, as in cases 
 of dropsy. Starch bandages, and bandages prepared 
 with plaster of Paris, are also used in the after treat- 
 ment of fractures, to enable the person to get more 
 readily about, and without running the risk that he 
 would otherwise do, if deprived of their support. But 
 the more usual kinds of bandages are those made of 
 cotton, bleached and unbleached, in the form of rolls, 
 and the triangular bandage, which will be afterwards 
 described. 
 
198 
 
 BANDAGING. 
 
 Roller bandages. — Of these, different sizes are em- 
 ployed, according to tlie part of the body it is desired 
 to encircle. Thus the finger bandage is j to 1 in. 
 wide, and from a yard to a yard and a half long. 
 Others are 2 in., 2^ in., 3 in., 4 in., &c., wide, and (> 
 yards long, that in most frequent use being the 2 in. 
 or 2J in. 
 
 It often happens, of course, that no made bandages 
 are at hand at the time when they are most par- 
 
 FiG. 82. — Bandage Winder. 
 
 ticularly wanted, and then it is necessary to make 
 what we require out of the material at our command. 
 Some pieces of old calico are generally to be procured, 
 and must be torn up into lengths of the required 
 width, and stitched together till we have got it 
 sufficiently long. 
 
 To roll the bandage. — Having torn and pieced the 
 calico, it becomes necessary to roll it up, and. it must 
 
BANDAGING. 
 
 199 
 
 not be supposed that tliis can be done just anyhow. 
 In hospitals and other institutions, where large num- 
 bers of bandages are required, a little machine is 
 kept for the purpose of rolling them, which both 
 facilitates this, and makes them much firmer than 
 they would otherwise be. But for ordinary purposes 
 the hand will answer well enough. When beginning 
 the bandage it will be better, in order to its being 
 
 I'lG. 83. — Method of Eolling a Bandage between the Hands. 
 
 compact, and to make its commencement easier, to 
 make the first few turns on an ordinary knitting wire, 
 and then proceed to roll carefully up, getting some- 
 one to pay out the calico for you, as in the diagram, 
 or it may be done independently of an assistant, by 
 using the left hand to roll while you keep the band- 
 age straight and tight with the right, or vice versdy 
 thus : — 
 
200 
 
 BANDAGING. 
 
 Having got your bandage ready, you must now 
 apply it to the part, and it should be remembered, 
 first to apply the bandage with the outer surface 
 ao-ainst the part to be bandaged; second, always 
 unroll from the inner towards the outer aspect of the 
 limb ; and it will be as well to keep the bandage 
 close to the skin or dressing, unrolling it as you 
 proceed, not unwinding a yard or so, and having it 
 hang loose about you. It must always be borne in 
 
 Fig. 81. — ^Method of "RoFiLiNG a Bandage whExV the Help of an 
 Assistant cannot be got. 
 
 mind, in regard to the instructions which follow, that 
 the bandaging is to be begmi at the inner aspect of 
 the limb, and passing outwards, and to do this suc- 
 cessfully, the person will require to use both the 
 right and left hand. The difficulty felt at first at 
 doing this will soon be got over after a little prac- 
 tice. Third, when the bandage, unrolled in the 
 above way, is about to leave a part uncovered, as is 
 certain to happen when we pass from a narrower to 
 
BANDAGING. 
 
 201 
 
 a wider surface, recourse must be had to tlie making 
 of what are called reverses, which will be explained 
 presently. 
 
 The roller bandage may be applied as a simple 
 spiral or as a figure- of-8, and as both these and the 
 making of reverses can be seen in bandaging the 
 leg from the foot to the calf, it will be as well to 
 show the method of doine this now. Take the loose 
 
 Fig. 85. — Method or Beginning to Bandage the Ankle and Leg. 
 
 end of the bandage and lay it against the inner side 
 of the foot, and hold it there with the other hand. 
 Then, taking the bandage across the instep, carry it 
 round the back of the ankle, and, raising the hand 
 for a moment from the loose end, grasp the roller 
 and pass it again to the other hand. It will then be 
 brought over the front of the ankle and instep, down 
 the outer side of the foot, and across the sole, thus 
 
202 BANDAGING. 
 
 making a figure-of-S, one or two turns of tlie 
 spiral should then be taken, after which figures-of-8 
 should again be begun, till the ankle joint has 
 been bandaged, and at the lower pai-t of the leg the 
 spiral is again to be proceeded with. After a few 
 turns have been taken, it will be found that the 
 bandage does not sit closely to the skin, and if we 
 continue, parts will be left uncovered, or pockets will 
 be formed, which will prove very uncomfortable. This 
 is now the time for making reverses, and we must 
 remember in making these that they should not be 
 
 Fig. 86.— Ordinary Spiral Bandige por the Foot and Leg. 
 
 over a bone, and ought to be at the outer side of the 
 limb. The bandage should be unwound for ten or 
 twelve inches, and the j)a^i"t unrolled be allowed to 
 hang loosely. The hand holding the bandage shoidd 
 then be turned downwards, so as to bring the outer 
 surface inwards, when a reverse will have been made. 
 These reverses, when neatly made, should be in the 
 same position all the way up the limb. Above the 
 calf reverses are unnecessary, and the ordinary spiral 
 may be again proceeded with. 
 
 To bandage the knee. — The knee is bandaged by 
 
BANDAGING. 
 
 203 
 
 means of tlie figure-of-8, but tliis may be done in 
 one of two ways, either by taking the first one or two 
 turns over the front of the knee-pan or patella, each 
 
 Fig. 87.— Reverse Spiral Bandage. 
 
 succeeding turn diverguig from this point, and form- 
 ing what is called the divergent spica. The other, 
 by commencing below the knee and making figures- 
 of-8, which gradually approximate till they meet 
 over the centre of the knee. These two forms are 
 employed where the knee alone is bandaged. In 
 
 Fig. 88. — Divergent Spica of the Knee. 
 
 other cases, in which the knee bandage is a con- 
 tinuation of the bandage of the leg, or is to be con- 
 tinued upwards upon the thigh, the figure-of-8 is to 
 
204 
 
 BANDAGING. 
 
 be employed over the joint, and afterwards tlie spiral, 
 witlL reverses, where they are required. 
 
 To bandage the groin. — The groin is bandaged in 
 the following way : — Make a couple of spirals round 
 the upper part of the thigh, bringing the bandage to 
 the inner side, pass it then along the groin and 
 
 Fig. 89.— Convergent Spica of 
 THE Knee. 
 
 FiG. 90.— Method of Bandag- 
 ing THE Knee when it is 
 intended to carry it 
 
 UPWAKDS UPON the 
 
 Thigh. 
 
 round the back, a little below the upper part of the 
 haunch bones, then carry it over the lower part of 
 the belly till it crosses the bandage already passing 
 along the groin. It is then taken round the back of 
 the thigh and along the groin, and round the back as 
 before, and this repeated till the part is covered. 
 
 To bandage the fingers. — Finger bandages vary 
 
BANDAGING. 
 
 205 
 
 in size from i to 1 in. broad, and are about a yard 
 or a yard and a half long. Tliey are applied as fol- 
 
 FiG. 91. — Spica of the Right Groix. 
 
 lows : — Take one or two turns round the wn'st leavino* 
 a loose end, then carry the bandage down along the 
 
 Fig. 92.— Finger Bandage. 
 
206 BANI)AGi:s"G, 
 
 back of the hand to that side of the finger which is 
 next the little finger, except it is the latter we are 
 bandaging, and passing by one or two spirals to the 
 tip, begin to bandage in a succession of spirals 
 towards the root, then carry the bandage across the 
 back of the hand and ronnd the wrist, when meeting 
 with the loose end we can unite them in a bow 
 knot. 
 
 To bandage the thumb. — The thumb may be ban- 
 
 FiG. 93.— Spica of the Thumb. 
 
 daged in a manner similar to the finger already 
 described, or if we wish to apply pressure to the 
 root, so as to check bleeding, which is often abundant 
 from a wound of this part, we shall make use of the 
 figure-of-8 bandage in the following way: — Take 
 one or two turns round the wrist as before, then 
 carry the bandage along the back of the thumb, and 
 between it and the forefinger, bring it round and 
 across the back of the hand, thence across the front 
 
BANDAGING. 207 
 
 of the wrist to the back of the thumb, when the same 
 thing is repeated till the part is all covered in, then 
 a turn or two is taken round the Avi'ist to finish. 
 
 To "bandage the hand. — Take one or two turns 
 round the wrist as before, pass the bandage across 
 the back of the hand to the roots of the fingers, then 
 bring it straight across the palm to the thumb side 
 of the hand, and passing up between the thumb and 
 forefinger, it is carried obliquely across the back of 
 
 1 
 
 Fig. 94. — Figure-of-S Bandage for the Wrist, 
 
 the hand to the wrist, when the same thing is 
 repeated, and continued as long as is necessary. 
 
 To bandage the wrist. — The wrist is bandaged by 
 a series of figures-of-8, thus : — Place the loose 
 end of the bandage in the palm of the hand, and 
 cany the other part over the ball of the thumb and 
 round the back of the wrist, across the palm to the 
 space between the thumb and forefinger. It is then 
 taken over the back of the hand, and over the 
 
208 
 
 BANDAGING. 
 
 Tipper part of tlie hand, and round the wiist as 
 before, carrying each turn a little higher up the 
 arm. 
 
 To Ijandage the arm. — The arm is bandaged like 
 the leg, by a series of spirals and reverses, beginning 
 as described for the bandage of the hand, by a figure- 
 of-8 round the wrist. 
 
 To bandage the elbow. — This joint is bandaged in 
 
 Fig. 95. — Bandage of the Akm showing how to make Keverses. 
 
 a manner similar to the knee, by means of figures- 
 of-8, the loops meeting in the hollow in front. 
 
 To bandage the armpit. — Take one or two turns 
 of a spiral round the upper arm, then carry the 
 bandage under the armpit and round the front of 
 the shoulder joint, then across the back behind the 
 neck, under the opposite armpit, across the chest to 
 the upper part of the shoulder, then round to the 
 
BANDAGING. 209 
 
 under part of the annpit, and up the front of the 
 shoulder, and round the back as before. 
 
 To iDandage the head, — There are two ways most 
 frequently employed in bandaging the head by means 
 of the ordinary roller. One of these is to begin 
 above one ear, leaving several inches of loose end, 
 and carrying the bandage horizontally across the 
 forehead and back of the head, bring it to the point 
 
 Fig. 6.— Bandage for the Axilla or Armpit. 
 
 from which we started. Then passing it under the 
 loose end, which is held in the opposite hand, the 
 bandage is made to pass transversely across the top 
 of the head, and being: brous^ht down in front of the 
 ear, is carried under the lower jaw and up behind 
 the loose end, over which it is bent, going forward 
 upon the brow as before. This may be repeated as 
 often as required, after which the bandage is fastened 
 in a bow behind the ear, or pinned or stitched. 
 
 o 
 
210 
 
 BANDAGINa. 
 
 The other is what is called the capelline, and 
 
 consists of a double roller, or two single rollers 
 
 Fig. 97. — Mrtiiod op Bandaging 
 THE Head. 
 
 Fig. 98.— Stellate Bandage 
 roil THE Head. 
 
 stitclied together. Taking one roller in each, hand, 
 the bandages are carried to the back of the head, as 
 low down as possible ; here the rollers change hands, 
 that in the right going to the left, and that in the 
 left going to the right, when one which is the loAver 
 
 Fig. 99.— Method op Applying the Capelline Bandage. 
 
BANDAGING. 211 
 
 is carried up to the top of the head, and forward to 
 the root of the nose, the other hand meanwhile bein^* 
 canned forward crosses over this, when the bandage 
 which was carried to the root of the nose is turned 
 up over that passiiig- across the forehead, and is 
 carried back a little to one side of the middle line on 
 the top of the head till it reaches the middle line at 
 the back of the head. The horizontal roller passino- 
 backward from the forehead has now reached the 
 
 Fig. 100. — Appearance of Capelline Bandage when 
 Peoperly Applied. 
 
 back of the head, and is carried across the vertical 
 one, which is taken up to the top of the head a little 
 to the opposite side of the middle line from that 
 which came up from the forehead. This is continued 
 in like manner till the whole head is covered in, when 
 one or two horizontal turns are taken to finish ofp 
 with. 
 
 The many-tailed bandage,— Where it is desirable 
 to protect the movement of a limb, which would be 
 necessitated b}^ the employment of the ordinary roller 
 
212 BANDAGING. 
 
 bandage, it is customary to use the one called the 
 " many-tailed." This can be made in either of two 
 ways, by getting a piece of calico large enough to 
 surround the limb one and a half times, and tearing 
 it from each side in pieces of about two or three 
 inches broad, leaving a portion two or three inches 
 wide all the way up the centre untorn, or by cutting 
 an ordinary roller bandage into lengths, each long 
 enough to surround the limb one and a half times, 
 and stitching these to a central piece, each over- 
 lapping the other to a slight extent ; in this way a 
 greater amount of support can be given to the part. 
 
 The triangular "bandage. — This form of bandage is 
 of frequent use among ambulance classes, and owing 
 to its convenient size, the ease with which it can be 
 made, and the multiplicity of uses to which it can be 
 put, ought certainly to be familiar to all who may be 
 called upon to render " first aid." It consists of a 
 triangular piece of calico, whose base is about a yard 
 and a half long, and the sides about a yard. It may, 
 however, be used of proportionately smaller dimen- 
 sions. It can be used as a sling, as a bandage for 
 the head, for nearly any part of the body, or to keep 
 splints in their places. 
 
 A few of the uses to which this important bandage 
 may be put are noticed on the next page, but for a 
 detailed representation, one of the pictorial bandages 
 should be procured from any of the ambulance 
 associations in the country. 
 
BANDAGING. 
 
 213 
 
 Triangular bandage used as a sling. — Por this 
 purpose, and where the arm and elbow require sup- 
 port, the base of the triangle is placed under the 
 wrist, the apex being beyond the elbow. Suppose it 
 is the right arm we wish to sling, the portion of the 
 bandage passing under the arm nearest the chest 
 is carried up over the left shoulder, and meets the 
 outer part coming up over the right shoulder, when 
 
 Fig. 101.— Large Sling foe 
 THE Arm. 
 
 Fig. 102.— Small Sling por 
 THE Arm. 
 
 the ends are tied in a bow, or pinned to the coat, 
 preferably the latter, as it prevents the dragging 
 feeling which is complained of when there is a knot. 
 The apex is then brought forward and pinned to the 
 
 front of the slingf. 
 
 Where it is required to support the wrist the 
 bandage is folded up like an ordinary scarf till it is 
 
214 
 
 BANDAGING. 
 
 about six inclies broad, when it is applied in a similar 
 manner to the other. 
 
 As a head bandage. — Take the bandage in both 
 
 Fig. 103. — Triangular Bandage AprLiEO to the Head. 
 
 hands, lay it over the top of the head with the base 
 at the forehead, and the apex hanging down towards 
 the neck, pass the hands backwards, crossing them 
 over the top of the bandage at the back of the head, 
 and bring the ends round to the forehead, where they 
 are tied. The apex is then lifted up over the part 
 where the ends cross and pinned. 
 
 To bandage the hand, — When it is necessary to 
 apply this bandage to the hand, the hand should be 
 
 J^ 
 
 ^•#li| 
 ^*iili 
 
 Fig. 104.— Hand Bandage. 
 
BANDAGING. 
 
 215 
 
 laid upon it with the base at the wi'ist ; the apex is 
 then to be folded up over the palm towards the wrist, 
 and the two ends crossed over and tied. 
 
 To retain splints in position. — For this purpose 
 
 Fjg. 105.— Triaxgulak Baxdages used to keep Splints ix theik 
 Proper Places. 
 
 the bandage is folded up like a scarf, as in the lesser 
 sHng", and passed round the limb encirchng it and 
 the spUnts, crossed and tied at the outer aspect. 
 
 TUE END. 
 
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 MoRTiMKR Granville. 
 
 41 Beeton's Dictionary of Natural History. Illustrated. 
 
 42 The Dictionary of Every-day Difficulties. 
 
 43 Webster's Illustrated Spelling Book. 
 
 44 Beeton's Book of Songs. New and Improved Edition. 
 
 45 The Human Body : Its Structure, Functions, and Design. 
 47 M'Phun's Universal Gazetteer. Pocket size. 
 
 WARD, LOCK & CO., London, Melbourne, and New York. 
 
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