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Charles Field Mason.

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

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drowning, water gets ipto the air passages and mechanically shuts
off the air. Finally when anesthetics, such as ether or chloroform,
are given, asphyxia may result from an insufficient admixture of air.

The treatment of asphyxia consists first in removing the cause,
second in, restoring the breathing by artificial respiration. If the
patient is overcome by gas remove him to the fresh air, if he is taking
an anesthetic stop it, if he is buried in a snow-slide dig him out as
quickly as possible, if there is a piece of meat in the throat put your
finger in and hook it out or beat him between the shoulders and jar
it out. If the larynx is obstructed by membrane it may be necessary
to make an opening into the trachea (tracheotomy) and put in a
tube ; if the patient is hanging cut him down ; if he has been drowned
get the water out of his air passages," do these things first, then
perform the artificial respiration.

Artificial respiration seeks to imitate the natural breathing. There
are several methods, the following recommended by the " Com-
mittee on Resuscitation from Electric Shock," is probably the best,
as it can be done with the least difficulty by one man.

Proceeds as follows: (a) Lay the subject on his belly, with

(130)



ASPHYXIA



131



arms extended as straightforward as possible and with face to one
side, so that nose and mouth are free for breathing. Let an assistant
draw forward the subject's tongue.




FIG. 75. Artificial Respiration. Inspiration; Pressure Oft.



(b) Kneel straddling the subject's thighs and facing his head;
rest the palms of your hands on the loins (on the muscles of the




FIG. 76. Artificial Respiration. Expiration; Pressure On.



small of the back), with fingers spread over the lowest ribs, as in

Fi - 75-

(c) With arms held straight, swing forward slowly so that the
weight of your body is gradually, but not violently, brought to bear



132 FIRST AID

upon the subject (see Fig. 76). This act should take from two to
three seconds.

Immediately swing backward so as to remove the pressure, thus
returning to the position shown in Fig. 75.

(d) Repeat deliberately twelve to fifteen times a minute the
swinging forward and back a complete respiration in four or
five seconds.




FIG. 77. Artificial Respiration. Marshall Hall's method. Expiration.

(e) As soon as this artificial respiration has been started, and
while it is being continued, an assistant should loosen any tight
clothing about the subject's neck, chest or waist.

Continue the artificial respiration (if necessary, at least an hour),
without interruption, until natural breathing is restored, or until a
physician arrives. If natural breathing stops after being restored,
use artificial respiration again.

Do not give any liquid by mouth until the subject is fully conscious.

Give the subject fresh air, but keep him warm.

Pause for a moment occasionally to see whether the patient makes
any effort to breathe ; if he does, time your movements so as to cor-



ASPHYXIA



133



respond to the natural inspiratory and expiratory efforts. Usually
the first signs of success are a change in the color of the face and
faint sighing.

Meanwhile efforts should be made to excite respiration in other
ways ; apply snuff, tobacco, pepper, or smelling salts to the nostrils,
and strike the chest with towels dipped in hot and cold water
alternately.

Marshall Hall's method: In this method the patient is placed on
the floor or ground with the face downward, his forehead resting on




FIG. 78. Artificial Respiration. Marshall Hall's method. Inspiration.

one arm, and a roll of clothing supporting his chest. While in this
position the weight of the body compresses the ribs and expels the air
from the chest an artificial expiration which is increased by mak-
ing pressure on the lower ribs (Fig. 77). Then the operator, with
one hand on the patient's free arm, near the shoulder, and the other
placed under or in front of the corresponding hip bone, rolls the
body from face downward to its side and a little beyond (Fig. 78).
An assistant aids in this movement by handling the head and under-
lying arm. When the body has been thus rolled somewhat more than



134



FIRST AID



half round, the chest becomes relieved from superincumbent weight,
and a certain volume of air enters. After resting a second or two
in this attitude of inspiration, the patient is returned to the prone
position, and pressure made along the ribs to imitate the expiratory
act.

Drowning: There are wide differences of opinion as to how long
a man may remain under water after drowning and yet be resusci-
tated. It is probable that five minutes is the limit, but inasmuch as
no record is usually kept of the time and it may be actually much
less than what it appears under the influence of excitement, it is well
to make an effort at artificial respiration unless the time is actually
known to have been greater than a quarter of an hour.




FIG. 79. Getting Water Out of the Lungs.



To clear the lungs of water preliminary to artificial respiration
turn the patient on his face with his forehead resting on his wrist and
a roll of clothing under his chest ; then getting astride the body press
on the back to force out the water; next drop your hands under his
abdomen and lift up his body with the head hanging down so that the
water will run out (Fig. 79).

Besides artificial respiration it is necessary to restore the heat of



ASPHYXIA 135

the body, which is rapidly lost by immersion in the water, and to
stimulate the circulation.

While efforts at artificial respiration are going on remove the wet
clothing, wrap the body in dry, hot blankets, apply hot-water bottles
to the feet, and rub the limbs actively toward the heart, stimulants
should be given hypodermically, by the rectum, and by the mouth
when the patient can swallow.

When respiration is established put the patient in a hot bath until
the body heat and circulation are restored. Even when artificial
respiration is successful after drowning, congestion of the lungs,
bronchitis, or pneumonia is apt to result from the cold and the irrita-
tion of the lungs by the water which has gotten into them ; to prevent
these complications large mustard plasters should be applied to the
chest.



CHAPTER IX

POISONING

POISONS may be divided into two classes, those which are takeki
internally or hypodermically and those which are applied to the skin.

Of those taken internally the caustic acids and alkalies may also
be applied to the skin ; in either case they produce burns. When
swallowed the burns are upon the lips, in the mouth, throat, and
stomach. The stains are seen upon the lips, and the symptoms are
intense pain and agony, and vomiting of bloody matter mixed with
mucus and shreds of membrane. The treatment consists in trying to
neutralize the poison, protecting the burnt surfaces by administering
soothing substances such as oils, milk, white of eggs, flour and water,
etc., and relief of pain by opiates.

The caustic alkalies, such as lye, are best neutralized by vinegar or
lemon juice and water, and the caustic acids, such as sulphuric and
nitric, by magnesia, cooking or washing soda, tooth powder, or soap
suds. The remainder of the internal poisons may be divided in three
general classes :

1. Those whose principal effect is upon the gastric-intestinal canal,
causing violent irritation or inflammation, such as arsenic, corrosive
sublimate, nitrate of silver, oxalic acid, croton oil, and sugar of lead.

2. Those which produce little or no local irritation, but have a
poiverful general effect, especially upon the nervo'us system; such as
opium, chloral, belladonna, prussic acid, and strychnine.

3. Those which are both local and general poisons; such as phenol,
cantharides, phosphorus, and aconite.

In the treatment of cases of poisoning our first object is to empty
the stomach and prevent the absorption of any poison that may be
left in it; then to relieve pain and obviate the tendency to death.

An emetic is ordinarily used to empty the stomach, and those
which are most readily available are warm water, mustard, salt, and
ipecac ; give a tablespoonful of mustard or salt or a half-teaspoonful
of ipecac dissolved in a half-pint of tepid water; encourage vomiting

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POISONING 137

by running the fingers down the throat or tickling it with a feather;
the water should be tepid to produce nausea, and vomiting should*
be repeated until the water returns clear. If a stomach tube is
available the stomach should be washed out.

To prevent absorption we give an antidote, that is something that
will destroy the poison or its effects, usually rendering it insoluble.

^ Antidotes are general and special The general antidotes are
given when we do not know the exact nature of the poison ; thus tan-
nic acid and substances such as tea which contain it are antidotal to
the poisonous alkaloids and therefore to most vegetable poisons, and
albumin and substances such as white of egg, milk, etc., which con-
tain it are antidotal to most mineral poisons. The special antidotes
should be used when we know the exact nature of the poison;
hydrated magnesia or hydrated oxide of iron is the special antidote
to arsenic, salt to the nitrate of silver, chalk or tooth powder to
oxalic acid, soluble sulphates such as Epsom or Glauber's salts to
phenol and sugar of lead, sulphate of copper to phosphorus, and
permanganate of potash to opium.

The antidote is given at the same time as or immediately after the
emetic.

The relief of suffering calls for soothing, bland liquids, such as
olive oil or milk when there is burning pain in the stomach and
bowels, and also for morphine hypodermically.

To obviate the tendency to death observe in what way life is threat-
ened and endeavor to counteract that effect. If there is shock and
collapse, use stimulants, warmth, and rubbing; if the heart is failing
as in poisoning by aconite, chloral, or prussic acid stimulate it by hot
coffee, strychnine, digitalis, etc. ; if there is failure of respiration as
in phenol poisoning use coffee, cold douching, and artificial respira-
tion ; if there are violent convulsions as in strychnine poisoning use
bromides, chloral, or chloroform; if there is tendency to sleep keep
the patient awake by the administration of coffee, slapping the face
and chest with a wet towel, and walking him about.

To sum up : if you do not know what the poison is, but there are
signs of burning or caustic action about the mouth and lips, do not
give an emetic, give a tablespoon ful of bland oil, such as olive oil or
cottonseed oil, or castor or cod-liver oil ; get the patient to bed, relieve
his pain, put mustard plaster over the stomach, and try to keep him
alive. You do not give an emetic in such cases because the burned



138 FIRST AID

stomach might give way in vomiting, and the caustic would burn as
much coming up as it did going down.

If you do not know what the poison is, but the lips and mouth are
not burned, give an emetic followed by two or three raw eggs, a glass
of milk, or flour and water, and then a cup of strong, hot tea, after
which relieve pain and obviate the tendency to death.

When you do know the poison give the emetic, and the antidote ;
then relieve pain and keep the patient alive.

Among the substances which most commonly cause poisoning are
phenol, opium, wood alcohol, foods, chloral, arsenic, corrosive sub-
limate, nitrate of silver, phosphorus, and strychnine.

Phenol is usually taken in concentrated form, and may produce
death in an hour or two. The symptoms are white patches on the
lips, burning pain in the stomach, intense depression, cold, clammy
skin, weak pulse, failing respiration, stupor, and death. The anti-
dotes are the soluble sulphates and albumen, but they cannot be
depended upon. Give emetics, then wash out the stomach thoroughly
with water containing about two ounces of Epsom or Glauber's salts,
then give two raw eggs or a pint of milk. Perform artificial respira-
tion and use stimulants, heat and rubbing.

When phenol is dropped on the skin, alcohol, if used promptly,
will completely prevent any burning.

Opium. The treatment of opium poisoning has been described
on page 129.

Wood alcohol or methyl alcohol is a very dangerous poison used as
a fuel, and in the manufacture of toilet preparations such as bay rum.
The symptoms of poisoning by it are severe pains in the head and
abdomen, dizziness, vomiting, delirium, partial or complete blindness,
dilated pupils, great depression of the heart and respiration, some-
times albuminuria. stupor, and death. If the patient recovers he is
often left blind.

The treatment consists in use of emetics, or washing out the
stomach, emptying the bowels by cathartics and enema, active stimu-
lation by whisky and coffee internally and strychnine hypodermically,
artificial respiration if necessary, and external warmth.

Ptomaine poisoning is usually due to the use of foods which have
undergone partial decomposition, though there may be no change in
their taste or odor. The poisonous decomposition is especially apt to
occur in hashes, milk, or foods containing milk which have been kept



POISONING 139

over night in warm weather. Sausage, cheese, and shell-fish some-
times undergo the same changes. Many cases of poisoning of this
kind have occurred at military posts; sometimes whole companies
have been poisoned at the same time.

The symptoms are much like those of wood-alcohol poisoning, only
vision is not usually affected and there may be some fever and some
purging.

In treatment the first thing to do is to empty the stomach and
bowels of the poison by the use of emetics and active cathartics.
Then relieve pain and give stimulants with heat externally and
mustard plasters over the abdomen.

Chloral is the drug usually employed to make " knockout drops"
It causes deep sleep followed by insensibility, with failure of the
heart and stometimes the respiration. Empty the stomach and keep
the patient awake by the same means as in opium poisoning, except
that on account of his weak heart the patient must not be made to
walk about as in opium poisoning, and for the same reason strychnine
must be freely used hypodermically.

In arsenic poisoning fhere is great pain in the abdomen, with vomit-
ing and .purging, tenderness, straining and perhaps suppression of
urine, severe depression and anxiety, weak, rapid pulse, and cold,
clammy skin. Use emetics or the lavage tube, give a tablespoonful
of freshly prepared hydrated oxide of iron every ten minutes for
five or six doses. The hydrated oxide is prepared by precipitating
the tincture of the chloride of iron with aqua ammonia, and wash-
ing the precipitate to remove the excess of ammonia. Then give
morphine, stimulants, and soothing drinks, with external heat and
friction.

Corrosive sublimate may be swallowed by mistake in the form of
an antiseptic solution. The symptoms are about the same as in
arsenic poisoning and the treatment is much the same except that
the antidote is albumen instead of hydrated oxide of iron, and that
the antidotal effect is only temporary so that emetics must be used
after the- antidote.

Nitrate of silver may be swallowed accidentally as when a piece of
lunar caustic breaks off and drops down the throat. Common table
salt dissolved in water should be given freely ; it is at once a special
antidote and an emetic.

Phosphorus is sometimes taken in the form of match-heads. It



140 FIRST AID

is an irritant poison like arsenic and corrosive sublimate. Sulphate
of copper is the antidote and also an emetic ; it should be given one-
fifth of a gram every five or ten minutes with tepid water.

Phosphorus is the one irritant mineral poison for which oils should
not be given because its absorption is favored by them.

Strychnine causes violent convulsions with intervals of rest; there
are also pains and cramps in the abdomen. Death is the result of
asphyxia in the convulsions or exhaustion following them. Use
emetics or the lavage tube, bromides and chloral, chloroform.

Substances zvhich produce poisoning when applied to the skin are
chiefly plants of the rhus family such as " poison oak," " poison ivy,"
and " poison sumac." Other plants such as the common garden
parsnip produce poisoning occasionally.

Some persons are not susceptible while other persons are so much
so that they appear to be poisoned even without actual contact.
" Poison oak " is a stubby plant with three leaflets notched on the
edge and downy on the under surface ; " poison ivy " climbs on rocks
and trees ; it is distinguished from " Virginia creeper," which it
resembles, by having three leaflets instead of five and by having a
hairy trunk and little clusters of white berries ; " poison sumac " is
distinguished from the harmless variety by having white berries
instead of red. The symptoms of rhus poisoning are an inflamma-
tion "of the skin closely resembling erysipelas, redness, swelling,
burning and itching, sometimes vesicles ; it is especially apt to occur
on exposed parts such as the face and hands.

The treatment consists in dissolving off any remaining poison with
alcohol and then applying alkaline lotions, such as a saturated solu-
tion of bicarbonate of soda.



PART IV

NURSING

NURSING in post and field hospitals is ordinarily done by mem-
bers of the hospital corps. In general hospitals, base hospitals, and
other fixed hospitals of active service it is done by the nurse corps
(female) and the hospital corps.

The conditions most essential to the recovery of the sick are rest,
absolute cleanliness, and an abundance of fresh air, and these the
nurse should always seek to secure. Not all hospital corps men are
fit to become nurses, but all must receive training in this subject in
order to show whether or not they possess the aptitude. Study and
experience are both necessary and the two must go together.



CHAPTER I

THE WARD

THE wards of all post hospitals are arranged on the same general
plan.

The number of beds in each ward varies from twelve to eighteen
and usually there is connected with 'each a toilet-room with baths,
basins and water-closets, and a wardmaster's room. Near the ward
is a room or cabinet for patients' effects, and a linen closet sufficient
to contain enough linen for current ward use.

The beds are arranged in pairs between adjacent windows, with
a space of thr.ee feet between the beds and three and a half feet
between each pair of beds. About 100 feet of floor space and 1,200
cubic feet of air space are allowed to each bed ; in the tropics this
should be increased to about 150 square feet floor space and 3,000
cubic feet of air space; in wards for infectious diseases the floor
space should be the same as that allowed for the tropics.

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142



NURSING




Between each pair of beds is a chair, and adjoining each bed a
glass and iron bedside table; this with a folding bed-screen con-
stitutes the official furniture of the ward which is purposely made
as free as possible from appliances which are not only useless but
collecting places for dirt and disease germs. Usually, however,
there is a table for the wardmaster or nurse, and an-
other with a small cabinet to contain ward medicines,
Field hospitals, which have an ordinary capacity of
216 beds, are for temporary use only, to supply shelter,
food, and emergency treatment and are, therefore, not
supplied with cots or furniture ; the patients are placed
on straw, covered by blankets.

The post hospital ward is heated by hot water or
steam and ventilated by special openings for entrance
and exit of air. These air shafts are calculated to
introduce three thousand six hundred cubic feet of
fresh air per hour per patient. The entering air is
warmed by passing over hot-water coils beneath the
floor, while foul -air escapes through shafts artificially
FIG. 80. win- heated by hot- water pipes so as to produce an up

dow Ventilation; '

board below low- draught.
er sash.

When no special arrangements are made for ventila-
tion the natural openings of the ward, such as doors and windows,
are used for the purpose. The object must be to introduce as much
fresh air as possible without reducing the tem-
perature of the ward below the normal standard
of 68 to 70 F., and without causing unpleasant
draughts.

One of the simplest plans to secure 'ventilation
when this is not specially provided for is to place
a board under the raised lower sash, the air pass-
ing in between the sashes (Fig. 80), or to pull
down the upper sash and protect the opening by
a sloping board ( Fig. 8 1 ) . In either case the cold
entering air is directed upward. Occasionally
it is necessary to flush out the ward by opening wide the doors and
windows for a few minutes; in such cases the patients should be
thoroughly wrapped up as if out of doors.

Each ward is, under the care of a noncommissioned officer or




FlG gi. Window
! b a r d



THE WARD 143

private first class assigned as wardmaster, who is responsible for
the comfort, diet, and medication of the patients, the performance
of their duty by the nurses, the preservation of the ward property,
the regulation of the heat, lights, and ventilation, and the cleanliness
of the bed linen and clothing, lavatories, baths, water closets, etc.
One nurse is sufficient for a ward of twenty beds when the cases are
not of an acute character, but two may be required under special
conditions.

The wardmaster or nurse accompanies the medical officer on his
rounds, takes down his directions in the ward book, and sees that
they are carried out. Each nurse has specified duties assigned to
him, so that each may know exactly what is expected of him. He
should from the first cultivate habits of observation, neatness, and
system. Each time he passes about his ward he should observe the
condition of his patients, the beds, chairs, tables, etc., and should at
once correct anything that is out of order. There should be a place
for everything and everything in its place. When anything has been
used it should at once be cleaned and put back where it belongs, so
that when occasion for its use comes again no time may be lost in
looking for it and cleaning it.

When a medical officer unattended by a noncommissioned officer
enters the ward the wardmaster should at once arise and call atten-
tion and at the same time approach the medical officer to render any
assistance he may require; the same courtesy must be rendered the
commanding officer of the post or other authorized inspector.
When strangers enter the ward he should ascertain their business
and show them proper courtesies; they should not be allowed to
wander through the ward by themselves.

A wardmaster should never leave his ward without informing his
senior nurse where he is going and for how long and placing the
latter formally in charge.

The tour of a night nurse's duty usually extends from immediately
after dinner until after breakfast the following morning. The day
nurses serve the dinner to the patients and the night nurses the
breakfast; each completes his own work and cleans up everything
that has been used by him during his tour of service. The night
nurse renders a written report of all that has happened during the
night and turns over to the day nurse any instructions he may have
received.



144 NURSING

In each ward a book should be kept containing a complete inven-
tory of all the ward furniture, bedding, and appliances; when any
of these articles become soiled, worn out, or broken they are ex-
changed for clean or new ones, but the number of each should as
far as possible be maintained unchanged.

When a wardmaster is relieved in a ward he should turn over the
articles to his successor and take his receipt in the book.

Going on duty in the morning the nurse must begin at once to
get things in order for the morning rounds, usually at nine o'clock.
Chairs should be put in their places, bedside tables cleared of super-
fluous articles, and beds made up. Bed patients should have their
hands, faces, and teeth washed, and hair brushed. Convalescents
who are able to do so may be required to assist in the ward work.

The floors should be dusted with a floor brush covered with a cloth
wrung out of five per cent phenol solution and quickly polished
with the polishing brush, and if of tile scrubbed with soap and water
as often as necessary, and the chairs, tables, beds, and windowsills
freed from dust by a cloth dampened in the same solution.



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 11 of 38)