Charles Field Mason.

A complete handbook for the sanitary troops of the U. S. army and navy and national guard and naval militia online

. (page 10 of 38)
Online LibraryCharles Field MasonA complete handbook for the sanitary troops of the U. S. army and navy and national guard and naval militia → online text (page 10 of 38)
Font size
QR-code for this ebook

In the latter situation they are seen and removed with the greatest
difficulty, and the removal should not ordinarily be attempted by
other than a physician. To remove a foreign body from the eye the
best improvised appliance and one that is nearly always at hand is a
match. Light the match and after it has burned a moment blow it
out; then with a clean handkerchief and a circular movement of the
fingers wipe off the charred end, leaving a soft, aseptic, splinterless
point with which to remove the foreign body.

FIG. 74. Eversion of the Upper Eyelid.

To examine the lower lid draw it down with the fingers, at the
same time telling the patient to look up ; if the foreign body is not
found there, evert the upper lid (Fig. 74) by standing behind the
patient with his head upon your chest and telling him to look down
at his feet ; at the same time press a match or the end of the finger
firmly against the outside of the lid about a quarter of an inch
behind its margin, draw the lid down by the lashes and turn it
upward and outward over the match or finger tip. If the particle
is still not visible search the ball of the eye carefully for it, and when
it is found lift it off gently by a quick movement with the point of
the match. If the eye is very irritable it may be necessary to drop
in a little cocaine solution.

It is important to remember that even after a foreign body is re-



moved from the eye, there is often for some time a sensation as if
it were still there.

In the ear: The foreign body here may be an insect, a pea, or grain
of wheat, a pebble, a plug of hardened wax, etc. An insect in the ear
by its movements and buzzing often causes the most intense annoy-

Hold the head over on one side with the ear containing the insect
uppermost ; fill the ear with warm water ; this will drown the insect
in a few minutes, and then by suddenly turning the head to the other
side it may come out with the water; the maneuver should be re-
peated several times ; if the insect does not come away syringe the
ear. '

If the foreign body is vegetable, such as a pea, water should not be
used as it may cause the pea to swell and thereby render its extrac-
tion more difficult. If the pea is visible bend the loop end of a fine
hairpin, and try to get beyond it so as to hook it out. As there is
always danger of injuring the drum when instruments are pressed
into the ear, it should be a guiding rule that no instrument should
be passed beyond the point where its tip can be seen.

Hardened wax must be removed by syringing with a warm five
per cent solution of soda.

In the nose: Children push peas and such things into the nose, and
occasionally flies deposit their eggs there with the result that maggots
develop in the nasal cavity. Foreign bodies are best removed by
closing the free nostril with the finger and forcibly blowing through
the obstructed side ; snuffing up a little powdered tobacco or pepper
will cause sneezing and aid in the expulsion ; if this does not succeed
and the body can be seen it may be hooked out with the bent hairpin
in the same manner as described for the ear; or finally a small,
smooth stick or a slender pencil may be wrapped with a little cotton
and used to push the foreign body gently back through the posterior
nares into the mouth ; press straight backward, never upward.

Maggots in the nose is a very serious condition which may result
in death. Let the patient inhale through the nose a half -teaspoon ful
of chloroform, and while the maggots are stupefied syringe them out
with warm normal saline solution.

Foreign bodies in the throat are usually bones or masses of food.
If the bone can be seen and reached it may be removed by fingers or
forceps; if not, it may be carried down by eating dry bread. If the


obstruction is a mass of food it may be dislodged by forcible blows
on the back between the shoulders, or the fingers may be passed into
the throat to hook it out or to cause its ejection by vomiting.

Foreign bodies in the air passages cause violent cough and difficult
breathing; the case is urgent, and if a child he may be held up by his
heels and shaken; if an adult inversion may also be attempted and
blows between the shoulders given as in the case of foreign body in
the throat.

Foreign bodies are sometimes swallowed and reach the stomach
and intestines. Such cases are not usually serious. If the body is
angular or pointed, such as a tack or a pin, feed the patient on sub-
stances which leave considerable residue to cover and protect the
sharp points potatoes, bananas, bread, etc. Do not give laxatives
as they will render the movements liquid and thus leave sharp points

In the skin: Here we find splinters, thorns, needles, pins, fish-
hooks, pieces of glass, gunpowder, etc. For splinters and thorns pass
the point of the blade of a pocket-knife under them, with the thumb-
nail press the splinter against the blade and draw it out; or use a
pointed dissecting or dressing forceps. If the splinter is buried open
up the skin a little with the point of a knife or a needle until it can be
reached. If under a nail, make a notch in the nail so as to expose it.

If a needle or pin is broken off in the skin and can not be grasped
with forceps, cut a small hole in the end of a cork and press it down
over the point of entrance of the needle ; this may cause the needle to
emerge so far that it can be grasped. The needle may be so situated
that it is best to push it through and extract it on the other side. If
the needle or pin is in the foot or hand and can not be extracted, the
patient should be directed not to use the part, as muscular action will
cause it to work in deeper. A fishhook or an arrow can not be
drawn out on account of the barbs ; they must be pushed through.
Gunpowder is best removed by a thorough scrubbing with soft soap
and a stiff brush, the remaining grains being picked out with a



THE effects of heat may be general or local. The .general effects
of heat are manifested in two entirely different ways, viz. : heat
stroke and heat exhaustion.

Heat stroke, sunstroke, or insolation is due to prolonged exposure
to excessive heat, usually the heat of the sun. But heat stroke may
occur in hot rooms, and in the stoking-rooms of steamships. Ex-
haustion and improper clothing are powerful contributing factors,
hence it is especially apt to occur to soldiers on the march.

The premonitory symptoms are headache, dizziness, irritability,
frequent desire to urinate, seeing things red or purplish ; with or
without these symptoms the patient suddenly falls unconscious ; the
skin is dry and intensely hot; pupils contracted; pulse full and
strong; respirations snoring; there may be convulsions; if the tem-
perature of the body can be taken it will usually be found to be very
high, 105 F. to 109 F. or higher.

The condition is a very serious one and unless immediately re-
lieved terminates in death.

The treatment has for its object rapid reduction of the tempera-
ture. The man should be brought to the coolest accessible spot, in
the shade if out of doors, on deck if in the fire room of a steamer, his
clothing removed and an ice bag applied to his head and cold water
poured over him continually. At the same time the body may be
rubbed with ice, and if a tub is available he may be immersed in cold
water. The treatment should continue until the temperature is re-
duced. If the patient is able to swallow he should be given cold,
not iced, water to drink, and this should be repeated as often as

Serious results are liable to follow a sunstroke, even when death
does not occur ; the most common of these after-effects are perma-
nent headache, paralysis, mental confusion, or even insanity. More-
over, one who has had a sunstroke is ever after very susceptible to
the action of the sun.



Heat exhaustion is a very much less sever condition, closely
allied to fainting. It occurs among soldiers on the march and very
frequently among soldiers standing for some time at attention on a
hot day. The soldier suddenly drops his piece and falls ; he is not
unconscious or may be easily aroused ; face is pale, skin cool and
moist, pupils dilated or normal, pulse very weak ; respiration shallow,
perhaps sighing.

Such a patient should be moved into the shade, his clothing
loosened, equipments removed, head kept low, and a drink of water
or some stimulant given. On removal to the hospital he should be
kept perfectly quiet in bed and hot-water bags used if necessary.

The local application of heat produces burns or scalds.

Burns are produced by a flame, hot solids, or caustics. Scalds are
produced by hot liquids ; they differ only in that in the former the
hairs are destroyed, in the latter they are not ; the treatment is the

Burns are usually said to be of the first, second, or third degree.
Burns which merely cause redness are of the first degree; if blisters
are raised they are of the second degree; and if there are charring
and destruction of tissue the burn is of the third degree.

The symptoms of burn are shock which may be profound, chilly
sensations, and pain. The pain may be agonizing or slight.

The result of the burn depends more upon the extent of surface
affected than upon its depth, a burn of the first degree is almost cer-
tainly fatal if two-thirds of the surface of the body is affected, and
one of the second degree if one-third of the body is burned; the
chances for recovery are much less in children and elderly people.

The danger in the first twenty-four hours is from shock; after
that from internal congestions" and inflammations, suppression of
urine, ulceration of the duodenum, and intestinal hemorrhage ; and
finally from exhaustion, blood poisoning, or tetanus.

If the entire thickness of the skin is destroyed terrible deformities
are apt to follow the contraction of the skin which occurs in healing.

In burns of the first degree, of which sunburn is a type, soft cloths
dipped in a saturated solution of cooking soda should be applied,
and this followed by any fresh oil or fat ; cream or olive oil answers
excellently well.

In burns of the second and third degrees the objects of treatment
are first protection from the air which greatly aggravates the pain


and shock; secondly relief of shock, and third prevention of infec-

The quickest temporary means of excluding air is to immerse the
part or the entire body in warm water; then having gotten every-
thing ready carefully cut away the clothing, leaving such as is stick-
ing to the burned skin; blisters should be left undisturbed unless
they are very tense and painful, when they may be punctured by a
sterilized needle and the contents allowed to escape.

The wound should next be dressed with sterile gauze dipped in a
warm solution of boric acid, or a solution of picric acid ten parts in
eighty parts of alcohol and a thousand parts of water ; the picric acid
relieves the pain and has value as an antiseptic ; over the gauze place
a thick layer of sterile absorbent cotton. When the burns are ex-
tensive small portions only should be exposed and dressed at a
time. When the first dressing is finished it should be left on as
long as possible.

Meantime stimulants and hot drinks should be given internally
and morphine and strychnine injected hypodermically if necessary.

When there has been skin destruction the parts should be re-
tained in proper position by splints when healing is taking place.

In burns from corrosive acids, such as sulphuric and nitric acids,
the parts should be thoroughly flushed with water and a solution of
soda, after which the treatment is the same as for other burns.

In burns from caustic alkalies, such as lye, vinegar diluted with
water should be used to neutralize the alkali before applying the
usual treatment for ordinary burns.

When the clothing of a person, usually a woman, is on fire she
should be enveloped in a blanket, rug, cape, or woolen coat and
thrown upon the ground while the flames are smothered ; the reason
she should be thrown upon the ground is to prevent her from
running about and thus fanning the flames, and also because flames
rise, and in the erect position would reach the mouth and throat.

The effects of cold, like those of heat, may be general or local.

In general freezing there is at first a very unpleasant sensation of
cold with pain in the extremities, then numbness and stiffness, and
finally great drowsiness with an irresistible desire to lie down and
sleep, which if yielded to is soon followed by death.

When one is found in such a condition, life not yet being extinct,
he should be taken into a cold room, all clothing removed, and the


body rubbed briskly with sheets or towels wee with cold water. As
soon as the stiffness is removed artificial respiration should be per-
formed; and when the patient is able to swallow, warm drinks
should be given. When there are signs of returning consciousness
and circulation the body may be enveloped in a blanket and the
temperature of the room gradually raised.

The reason a frozen person must not be brought into a warm room
is that the sudden restoration of the circulation gives rise to violent
congestions and often to sudden death from the formation of clots
in the blood-vessels.

Local freezing is of two degrees, frost-bite and chilblain.

Frost-bite is usually of the extremities, fingers, toes, nose, or ears,
but a whole limb may be frozen. The part is at first red and painful,
then livid, and finally white, hard, and painless ; the sudden cessation
of pain in the freezing part is always a bad sign. The danger of
frost-bite is that sudden thawing may cause such severe congestion
as to result in gangrene.

Therefore the patient should not go into a warm room or near a
fire. Rub the part vigorously with wet snow or ice water, never
with dry snow as the temperature of dry snow may be much below
freezing, and rubbing with it would aggravate the condition. When
the pain and redness return apply cold dressings.

Chilblain is a condition of acute or chronic congestion occurring
especially in the feet, and due to bringing cold feet near the fire too
suddenly, or merely following exposure to cold in persons with
poor circulation. On the part affected are red spots, more or less
swollen, which burn and itch intensely. The treatment consists in
stimulating applications, such as liniments and tincture of iodine.
Susceptible persons should wear woolen socks.



AMONG conditions causing insensibility are fainting, shock, con-
cussion and compression of the brain, apoplexy, lightning stroke,
electric shock, heat stroke, freezing, epilepsy, Bright's disease, alco-
holism, narcotic poisoning, and asphyxia or suffocation.

Fainting is a condition due to too little blood in the brain, and
is caused by mental impressions, exhaustion, heat, bleeding, over-
crowded rooms, etc. The symptoms are sudden unconsciousness,
pale face, cool, moist skin, weak pulse, shallow breathing, and dilated

Treatment: Get more blood to the brain by laying the patient flat
on his back with the head low and the legs raised; sprinkle cold
water in his face and apply ammonia or smelling salts to the nostrils
to make him breathe, get him out of a crowd into the fresh air,
loosen the clothing about his neck and waist.

If he is sitting in a chair and about to faint the attack can often be
prevented by thrusting the head down between his own knees and
holding it there until the face becomes flushed.

Shock is a condition similar to fainting but due to physical injury.
It has been fully dealt with on page 90.

Concussion of the brain is the condition present when we say a
man has been " knocked senseless " or " stunned." It is a jarring
and shaking of the brain due to blows or falls upon the head or falls
upon the feet; the brain almost stops working for a while. The
symptoms are unconsciousness, pallor of the face, breathing so quiet
and shallow that it can hardly be detected, pulse fluttering, pupils
equal and usually contracted.

The degree of insensibility varies; sometimes the patient can be
aroused but is irritable and lapses again into unconsciousness which
may last minutes or hours. Vomiting and turning on the side are
favorable symptoms.

Treatment: Perfect rest in a dark, quiet room; warmth externally



if the surface is cold; aromatic spirits of ammonia internally or by
inhalation if there is much depression.

Compression of the brain is as its name implies a pressure on the
brain. This pressure is due usually to either a piece of bone or to
blood from a torn vessel which has escaped inside the cranium and
as it can not get out must compress the brain, and this compression
prevents certain parts of the brain from working. \Vhen the bleed-
ing is the result of injury the condition is called simply compression
of the brain ; when it is the result of the bursting of a diseased vessel
without any violence it is called apoplexy; the result and the symp-
toms are just the same.

The symptoms of compression are profound unconsciousness;
loud, snoring breathing ; slow pulse ; pupils usually unequal and not
reacting to light, and paralysis on one side of the body.

If the compression is due to a piece of broken bone the symptoms
come on immediately after the injury, while if it is due to bleeding
they may come on later and gradually.

Treatment: If the compression is due to a piece of depressed bone
the bone must be raised. If due to bleeding, the bleeding must be
stopped; surgical relief can only be given by a surgeon, but meantime
keep the patient quiet with his head slightly raised ; apply an ice bag
to the head, give him a hot mustard foot bath, and put a few drops
of croton oil in a teaspoonful of sweet oil on his tongue, so as to
send the blood from his brain to the feet and intestinal tract.

Lightning stroke may cause sudden death, insensibility, or severe
burns. If the patient is unconscious but living, effort should be made
to keep him alive; perform artificial respiration if the breathing
fails; give stimulants if the heart is weak, and apply heat externally
if the surface is cold. Burns must be treated like other burns.

Electric shock is caused by coming in contact with a " live wire " ;
spasmodic contraction of the muscles occurs so that the person can
not let go. The condition and results are exactly like lightning

The first thing to be done is to rescue the patient by setting him
free from the wire, and this must be done with great care, as to touch
him with the bare hands will cause the rescuer to get the same shock.

Immediately break the circuit. With a single quick motion, free
the victim from the current. Use any dry nonconductor (clothing,
rope, board) to move either the victim or the wire. Beware of using


metal or any moist material. While freeing the victim from the live
conductor have every effort also made to shut off the current quickly.

The treatment of the shock is the same as in the case of lightning

The forms of unconsciousness due to heat stroke and to freezing
have already been described.

Unconsciousness from acute alcoholism is the condition known as
" dead drunk." The patient is insensible, though he can usually be
partially aroused, the face is flushed and bloated, eyes bloodshot,
pupils usually dilated, skin cold and clammy, temperature subnormal,
respiration snoring, pulse rapid and weak ; there is no paralysis.

Treatment: The case is one of acute poisoning by alcohol. The
first thing to be done is to empty the stomach, by tickling the throat
or by giving an emetic of mustard or salt and warm water. Then
sprinkle cold water freely upon the face, but apply heat to the body ;
a cup of hot coffee may help to clear the brain after the stomach is
emptied. Usually an undisturbed sleep is necessary.

It must not be forgotten that alcoholism and apoplexy are fre-
quently confounded, the more so as a man who has been drinking
and has the odor of liquor upon his breath may be stricken with

In apoplexy there are paralysis, unequal or contracted pupils,
some fever, slow pulse; in alcoholism no paralysis, equally dilated
pupils, rapid pulse, subnormal temperature.

In epilepsy there may be fits with insensibility, or a mere momen-
tary unconsciousness with slight muscular twitching, but in which
the patient does not fall.

In the severe form, with or without some premonitory sign, the
subject suddenly cries out in a peculiar manner and falls in a fit ; at
first the entire body is rigid, then there are general convulsions with
jerking of the limbs, contortions of the face, and foaming at the
mouth; after a few minutes the convulsions are following by pro-
found stupor, and this generally passes off in deep sleep. During
the attack the eyeballs may be touched without the patient flinching,
the pupils are dilated, he often bites his tongue, and there may be
involuntary evacuations of the bowels and bladder.

Epileptic stupor may be distinguished from other forms of un-
consciousness by the history of the fit, and of other fits, by the foam


at the mouth and the bitten tongue, and by the absence of any

Treatment: You can do nothing to stop the fit or to control it; all
that can be accomplished is to prevent the patient from hurting him-
self and to make him as comfortable as possible ; do not attempt to
hold him, but twist a handkerchief and passing it between the jaws
tie it at the back of the neck to keep him from biting his tongue until
after the fit is over; after which let him sleep as long as he wishes.

Epileptic fits are frequently feigned by soldiers in order to secure
their discharges. The feigned attacks usually occur at night when
no one can see them ; the man does not fall so as to hurt himself, does
not bite his tongue, flinches when the eyeball is touched ; the pupils
are not dilated; the patient can be aroused; when there is foaming
at the mouth a piece of soap will often be found inside.

A pail of cold water suddenly thrown upon the man's head and
shoulders usually makes the diagnosis; it promptly revives the
malingerer, but has little or no effect upon the epileptic.

The insensibility of Bright 's disease is really an acute poisoning
from the retention of the waste products which the diseased kidneys
are not able to carry off. The unconsciousness is often attended
with delirium and convulsions. The pupils are contracted, the pulse
slow, and the breathing loud and snoring.

The distinguishing characteristics are the history of Bright's dis-
ease, the waxy color of the skin, sometimes dropsy, the equally con-
tracted pupils, the absence of paralysis.

Emergency treatment : Cold cloths to the head and a hot mustard
poultice to the back over the kidneys.

In opium poisoning the patient may be very sleepy or deeply un-
conscious, the pupils are minutely contracted, the respiration very
slow, as low as eight or ten to the minute, and snoring, and the pulse
rapid and weak. If the opium has been swallowed, empty the stom-
ach by an emetic, and then give a half gramme of permanganate of
potash dissolved in half a pint of water to destroy what opium is left.
Next keep the patient awake by giving him strong, black coffee,
pinching him, talking to him, and walking him up and down if pos-
sible, but not to the point of exhaustion.

Asphyxia or suffocation is another cause of unconsciousness, to
which it is necessary to devote a special chapter.



Asphyxia or suffocation is that form of unconsciousness due to the
cutting off of the supply of oxygen to the lungs. This may occur in
several ways. The air may be so full of some other gas that the
proper amount of oxygen cannot reach the lungs; this is what
happens in cases of poisoning from illuminating gas, the gases in
mines, etc.

When a person is buried up to his neck in a slide of earth or snow
he may be asphyxiated as a result of the inability to expand his chest,
even though the mouth and nose be free. The air may be cut off at
the mouth as when one is smothered by a pillow; in the throat by
the lodgment of food in the larynx, or its obstruction with the mem-
brane of diphtheria. The supply of air may be shut off by the pres-
sure of a rope or fingers when one is hanged or strangled. In

Online LibraryCharles Field MasonA complete handbook for the sanitary troops of the U. S. army and navy and national guard and naval militia → online text (page 10 of 38)