PART XXIX.

ACCIDENTS AND INJURIES TO PERSONS.

QUESTION 542. _In case an accident occurs and one or more persons are seriously injured, what can be done by those present?_

_Answer._ In such cases it very often happens that with knowledge and sufficient coolness to apply that knowledge, one or more non-medical persons who are present when an accident occurs can do as much or more toward saving life and allaying pain, _before_ a doctor comes, than he can _afterwards_. The following cases cited by Dr. Howe in his book on “Emergencies” will illustrate this:

“_Case 1._--A machinist was admitted to a New York hospital suffering from wounds of the wrist and palm of the hand. On arriving at the hospital the entire clothing on one side of his body was saturated with blood, from the loss of which he was partly insensible. On making an examination, it was found by the surgeon that a folded handkerchief was bandaged over the centre of the wrist, and that the wound in the palm of the hand was untouched. The pad was placed on the wrist, as if the greatest care had been exercised to avoid pressing on either of the two arteries. The bleeding in this case could easily have been controlled if the bandage and pad had been properly applied. The patient, however, developed erysipelas, and, not having sufficient vitality to carry him through, died the fifth day.”

“_Case 2._--A laborer fell from the front platform of a car at Harlem, and had his right foot crushed by one of the wheels. An ordinary bandage was placed on the limb without any compress over the vessels. In bringing the man to the hospital, the rough jolting of the carriage set the wound bleeding, and by the time he reached his destination he was apparently lifeless. The vessels were tied and stimulants administered, but he never rallied. Death occurred six hours after his admission. His injuries, independent of the bleeding, might indeed have terminated his life; still the chances would have been in his favor if a compress had been applied to the limb to prevent bleeding. The fact that such a thing was not done shows either culpable negligence or deplorable ignorance.”

Many similar cases constantly occur where a little intelligent timely action of those present would save the life of an injured person, who without such help must die before professional surgical aid can be obtained.

QUESTION 543. _When it is found that one or more persons are seriously injured, what is the first thing to be done?_

_Answer._ The first thing to do is to extricate the person or persons from the danger, and at the same time send a messenger for a doctor. If it is doubtful if one can be obtained by sending in one direction, send two or more messengers in different directions.

QUESTION 544. _To what kind of injuries are locomotive runners and other persons employed or traveling on railroads exposed?_

_Answer._ They are liable to be bruised or crushed in case of collision or running off the track, or of injury from falling off the train, or of being run over by a moving train. Brakemen and others whose duty it is to couple cars are liable to have their hands, arms or bodies crushed between the cars, and locomotive runners are sometimes burned or scalded if an accident happens to their engines. Train-men are also frequently exposed to very great cold in winter and heat in summer, and are thus liable to be frost-bitten or sun-struck. Passengers are seldom injured excepting through their own carelessness, unless in cases of collision or running off the track and the destruction of the cars. Strangers and even railroad employes are frequently run over by trains while walking on the track, and frequent accidents occur to deaf people in this way, and it is not very unusual to hear of train-men who sit on the main track at night while their trains are waiting on the side-track for another train to pass, go to sleep while in that position, and then are run over by the passing train.

QUESTION 545. _When persons are crushed or dangerously wounded, what are the chief immediate sources of danger and death when their wounds are not necessarily fatal?_

_Answer._ First, excessive bleeding in case an artery is ruptured; second, the shock to the whole system, from which the sufferer may not have the strength to recover.

QUESTION 546. _When does bleeding from a wound become dangerous?_

_Answer._ Profuse bleeding is always dangerous, but it should be remembered that bleeding occurs from two sources: first from the arteries, which are the vessels which convey the blood _from_ the heart, and second from the veins, through which the blood flows back to the heart. The first is called _arterial_ bleeding and the second _venous_ bleeding. Now it must be remembered that the heart is the great force-pump of the body, and that it supplies all parts of the body with blood, somewhat as the feed-pump of a locomotive supplies the boiler with water. The arteries referred to fulfill the same purpose that the feed-pipe does to a locomotive pump--they convey the fluid from the pump to the place where it is needed. Now the blood is forced into these arteries with a certain amount of pressure, so that if any of them are cut or injured the blood will flow out in a jet or spurt just as the water will escape from a feed-pipe if that is ruptured. The blood which flows through the veins back to the heart may, on the other hand, be compared to the water in the supply pipes of a locomotive pump, that is, there is very little pressure on it, and therefore if they are injured the flow of blood from them is less rapid than from the arteries. It will therefore be seen that arterial bleeding is much more dangerous, because the blood flows from them under a pressure.

QUESTION 547. _How can arterial bleeding be distinguished from venous bleeding?_

_Answer._ The blood is of a bright scarlet color, and is forced out in successive jets; each jet corresponds with the movements of the heart. This characteristic spurting is caused by the intermittent force-pump action of the heart, driving out the blood. Venous bleeding is distinguished from arterial by the dark-blue color of the blood when flowing from the wound. It never flows in repeated jets, but oozes slowly from the wounded surfaces. Venous blood is traveling toward the heart, and there is consequently little force behind to cause a more rapid flow. This form of bleeding is comparatively harmless, unless occurring from very large veins.[118]

[118] “Emergencies and How to Treat Them,” by Joseph W. Howe, M. D.

QUESTION 548. _How can the bleeding be stopped in case an artery is cut or ruptured?_

_Answer._ The most efficient and available method is the application of PRESSURE on the artery BETWEEN THE WOUND AND THE HEART. Under ordinary circumstances this can be most effectively done with what is called a _field tourniquet_, which is simply a handkerchief passed around the limb above the wound, the ends of which are then tied together. A pad is then made, either of cloth rolled up, a piece of wood, or a round stone about the size of a hen’s egg well wrapped, or any substance from which a firm pad can be quickly made, which is placed over the artery. The handkerchief is then placed over the pad and a short stick put through it on the opposite side of the limb and twisted around until the pad compresses the artery firmly. While the tourniquet is being prepared, some one should compress the artery with his fingers or thumb, so as to prevent as much loss of blood as possible.

QUESTION 549. _What is the position of the arteries in the body and how can their location be known?_

[Illustration: Fig. 230.]

_Answer._ The position of the principal arteries is shown in fig. 230. They proceed from the heart _h_ with branches, _a_, _a_, and _b_, _b_, which extend along each limb. These branches subdivide again below the knees and elbows, and again in the hands and feet. The position of the arteries can be felt by their pulsation at almost any part of them, but when they are buried below the muscles it is more difficult than when they are near the surface.

QUESTION 550. _In case of a wound and rupture of the arteries in the arm, what should be done?_

_Answer._ The artery at _a_ should be firmly compressed with the thumb until a bandage and pad from which a tourniquet can be made are prepared. The pad should then be applied over the artery and compressed as explained in answer to Question 548. The bleeding can also be stopped by placing a round piece of wood or other form of pad between the arm at _a_ and the body and then tying the arm tightly against the body, so that the pad will be pressed against the arm.

QUESTION 551. _In case of rupture to an artery below the knee, where should the pressure be applied?_

_Answer._ The artery approaches near the surface at _c_, _c_, immediately back of the knee, where it is represented in dotted lines in fig. 230. Pressure should therefore be applied at that point first with the thumb until a tourniquet can be applied. The bleeding can also be stopped by elevating the leg and allowing it to rest on the back of a chair or other similar support. The weight of the leg will then bring sufficient pressure on the artery to stop the bleeding. A towel or other soft material should be placed over the back of the chair, so that the pressure will not be too painful to the sufferer.

QUESTION 552. _If an artery is ruptured in the leg above the knee, where should the pressure be applied?_

_Answer._ In the thigh at _b_, where the beating or pulsations in the artery can be distinctly felt. The reader should familiarize himself with the position of the arteries by feeling their location in his own body. By doing so he may be able to save the life of a companion or other person in case of accident, whereas without such knowledge the injured person would die.

QUESTION 553. _After the arterial bleeding has been stopped, if blood should continue to ooze out of the wound, what should be done?_

_Answer._ The wound should be filled with lint or cotton waste; and the limb then be bandaged by beginning at its extremity and wrapping the bandage closely and evenly around it so as to bring, as nearly as possible, an equal pressure on the whole of it. Bandaging the limb in this way up to the point where the pressure is applied to the artery, will prevent swelling, and the veins will be compressed so that the blood will not flow from their torn extremities.

QUESTION 554. _When the bleeding has been stopped, what should be done?_

_Answer._ The injured person should be laid in as comfortable a place as can be procured for him, and should be given a moderate drink of water. If much exhausted, two or three tablespoonsful of brandy or whisky, mixed with an equal quantity of water, should be given first, and smaller quantities, _of not_ MORE THAN A TABLESPOONFUL at a time, should then be given every half hour. Usually wounded persons are given too much stimulant, so that frequently they are injured more than they are benefited thereby.

After a person has lost much blood, he feels an intolerable thirst, but if too much water is given him, he is apt to become sick and vomit, which weakens him still more. It is therefore best to give him very little water, say a teaspoonful at a time, after the first drink, or if ice can be obtained, give the sufferer pieces of ice frequently, which can be allowed to melt slowly in his mouth.

QUESTION 555. _When a person is insensible, what should be done for him?_

_Answer._ Lay him down in as comfortable a place as the circumstances will permit, and protect him from cold, rain or hot sun, as may be needed. A common error is to place injured and insensible persons in an erect position or in a chair. If he is insensible he should _always_ be laid down with his head slightly lower than his body. Then water should be dashed two or three times on his face, and warm bricks, stones or pieces of iron, such as coupling links or pins, applied to his feet and in the arm-pits and between the thighs, being careful that the warm objects applied are not hot enough to burn. Then cover the person with blankets, heavy coats or anything else which will keep him warm. Wounded persons soon become cold and chilled, the effects of which are very injurious, and therefore especial pains should be taken to keep them warm. In very cold weather there is great danger that injured persons will be frost-bitten, which must be carefully guarded against.

In case of shock, when the injured person lies pale, faint, cold and sometimes insensible, with feeble pulse and labored breathing, anything like excitement must be avoided, as it tends to exhaust the patient.

All assistance and attention should be given to a wounded person with the least noise and excitement, and all crowds and idle spectators should be driven away and every effort made to keep the sufferer comfortable and quiet. If food is given it should be in the form of beef tea or broth, and in small quantities at a time.

QUESTION 556. _In case any bones are broken, what should be done?_

_Answer._ The limb should be supported as comfortably as possible until a doctor’s services can be obtained. There is danger with a broken limb that the bones will protrude through the flesh and skin, to avoid which the limb should be placed in a natural position and laid on a pillow, car cushion or other soft object. This should then be wrapped around the limb and tied in this position, so as to prevent any movement of the broken bones.

QUESTION 557. _If a person is crushed or severely burned, what should be done?_

_Answer._ The immediate danger from such injuries arises from the “shock” to the system. It is usually best to bandage the part which is crushed until surgical aid can be obtained, and the sufferer treated as explained in answer to Question 548.

QUESTION 558. _What should be done for a person who has been burned or scalded?_

_Answer._ Lint or cotton waste saturated with molasses and water should be applied to the wound, or the latter should be dusted with wheat flour, and then dressed with lint or cotton waste, and loosely bandaged. If the injury should be severe, a shivering followed by depression is very likely to come on. To check this, warmth in the form of hot applications and stimulants should be used, as already explained.

QUESTION 559. _What should be done for a frost-bite?_

_Answer._ Warmth should be applied to the frozen part very gradually by rubbing with snow or pouring cold water on it. The occurrence of stinging pain, with a change in color, is a signal to stop all rubbing or other measure which might excite inflammation. If the frozen part turns black the next day, a poultice should be applied.

If persons exposed to the cold become very much exhausted or sleepy, stimulants should be given, as explained in answer to Question 554, and the body briskly rubbed with the hands and warm flannel or other woolen material.

QUESTION 560. _How should a person be treated who has been sun-struck?_

_Answer._ Apply cold water or ice to the head, place the sufferer in a cool place, and make him comfortable. After being sun-struck the person should not work for some days or weeks thereafter, until his health and strength are fully recovered.