Few subjects can more usefully employ the attention and study of engineers than the proper treatment and first remedies made necessary by the peculiar and distressing accidents to which persons are liable who are employed in or around a steam plant.

These and many other things of a like nature are likely to call for a cool head, a steady hand and some practical knowledge of what is to be done.

In the first moments of sudden disaster, of any kind, the thoroughly trained engineer is nearly always found, in the confusion incident to such a time, to be the one most competent to advise and direct the efforts made to avert the danger to life limb or property, and to remedy the worst after effects.

To fulfil this responsibility is worth much previous preparation, so that the best things under the circumstances may be done quickly and efficiently. To this end the following advice is given relating to the most common accidents which are likely to happen, in spite of the utmost exercise of care and prudence.

Burns and Scalds.—Burns are produced by heated solids or by flames of some combustible substance; scalds are produced by steam or a heated liquid. The severity of the accident depends mainly, 1, on the intensity of the heat of the burning body, together with, 2, the extent of surface, and, 3, the vitality of the parts involved in the injury, thus: a person may have a finger burned off with less danger to life than an extensive scald of his back.

The immediate effect of scalds is generally less violent than that of burns; fluids not being capable of acquiring so high a temperature as some solids, but flowing about with great facility, their effects become most serious by extending to a large surface of the body. A burn which instantly destroys the part which it touches may be free from dangerous complications, if the injured part is confined within a small compass; this is owing to the peculiar formation of the skin.

The skin is made up of two layers; the outer one has neither blood vessels nor nerves, and is called the scarf-skin or cuticle; the lower layer is called the true skin, or cutis. The latter is richly supplied with nerves and blood vessels, and is so highly sensitive we could not endure life unless protected by the cuticle. The skin, while soft and thin, is yet strong enough to enable us to come in contact with objects without pain or inconvenience.

The extent of the surface involved, the depth of the injury, the vitality and sensibility of the parts affected must all be duly weighed in estimating the severity and danger of an accident in any given case.

In severe cases of burns or scalds the clothes should be removed with the greatest care—they should be carefully cut, at the seams, and not pulled off.

In scalding by boiling water or steam, cold water should be plentifully poured over the person and clothes, and the patient then be carried to a warm room, laid on the floor or a table but not put to bed, as there it becomes difficult to attend further to the injuries.

The secret of the treatment is to avoid chafing, and to keep out the air. Save the skin unbroken, if possible, taking care not to break the blisters; after removal of the clothing an application, to the injured surface, of a mixture of soot and lard, is, according to practical experience, an excellent and efficient remedy. The two or three following methods of treatment also are recommended according to convenience in obtaining the remedies.

Take ice well crushed or scraped, as dry as possible, then mix it with fresh lard until a broken paste is formed; the mass should be put in a thin cambric bag, laid upon the burn or scald and replaced as required. So long as the ice and lard are melting there is no pain from the burn, return of pain calls for a repetition of the remedy.

The free use of soft soap upon a fresh burn will remove the fire from the flesh in a very little time, in ¹/₄ to ¹/₂ an hour. If the burn be severe, after relief from the burn, use linseed oil and then sift upon it wheat flour. When this is dried repeat the oil and flour until a complete covering is formed. Let this dry until it falls off, and a new skin will be formed without a scar.

In burns with lime, soap lye, or any caustic alkali, wash abundantly with water (do not rub), and then with weak vinegar or water containing a little sulphuric acid; finally apply oil, paste or mixture as in ordinary burns.

It would be well to always keep ready mixed an ointment for burns; in fact a previous readiness for an accident robs it of half its ill effects.

Glue Burn Mixture.

A method in use in the N. Y. City Hospital known as the “glue burn mixture” is composed as follows: “7¹/₂ Troy oz. white glue, 16 fluid oz. water, 1 fluid oz. glycerine, 2 fluid drachms carbolic acid. Soak the glue in the water until it is soft, then heat on a water bath until melted; add the glycerine and carbolic acid and continue heating until, in the intervals of stirring, a glossy strong skin begins to form over the surface. Pour the mass into small jars, cover with parafine papers and tin foil before the lid of the jar is put on and afterwards protect by paper pasted round the edge of the lid. In this manner the mixture may be preserved indefinitely.

“When wanted for use, heat in a water bath and apply with a flat brush over the burned part.”

Insensibility from Smoke.—To recover a person from this dash cold water in the face, or cold and hot water alternately. Should this fail turn the patient on his face with the arms folded under his forehead; apply pressure along the back and ribs and turn the body gradually on the side; then again slowly on the face, repeating the pressure on the back: continue the alternate rolling movements about sixteen times a minute until breathing is restored. A warm bath will complete the cure.

Heat-stroke or Sun-stroke.—The worst cases occur where the sun’s rays never penetrate and are caused by the extreme heat of close and confined rooms, overheated workshops, boiler-rooms, etc. The symptoms are: 1, a sudden loss of consciousness; 2, heavy breathing; 3, great heat of the skin; and 4, a marked absence of sweat.

Treatment.—The main thing is to lower the temperature. To do this, strip off the clothing, apply chopped ice wrapped in flannel to the head; rub ice over the chest, and place pieces under the armpits and at the side. If no ice can be had use sheets or cloths wet with cold water, or the body can be stripped and sprinkled with cold water from a common watering pot.

Cuts and Wounds.—In these the chief points to be attended to are: 1, arrest the bleeding; 2, remove from the wound all foreign bodies as soon as possible; 3, bring the wounded parts opposite to each other and keep them so; this is best done by means of strips of adhesive plaster, first applied to one side of the wound and then secured to the other; these strips should not be too broad, and space must be left between the strips to allow any matter to escape. Wounds too extensive to be held together by plaster must be stitched by a surgeon, who should always be sent for in all severe cases.

For washing a wound, to every pint of water add 2¹/₂ teaspoonfuls of carbolic acid and 2 tablespoonfuls of glycerine—if these are not obtainable, add 4 tablespoonsful of borax to the pint of water—wash the wound, close it, and apply a compress of a folded square of cotton or linen; wet it in the solution used for washing the wound and bandage down quickly and firmly. If the bleeding is profuse, a sponge dipped in very hot water and wrung out in a cloth should be applied as quickly as possible—if this is not to be had, use ice or cloth wrung out in ice water.

Wounds heal in two ways. 1, rapidly by primary union, without suppuration, and leaving only a very fine scar. 2, slowly by suppuration and the formation of granulations and leaving a large red scar.

Bleeding.—This is of three kinds: 1, from the arteries which lead from the heart; 2, that which comes from the veins, which take the blood back to the heart; 3, that from the small veins which carry the blood to the surface of the body. In the first, the blood is bright scarlet and escapes as though it was being pumped. In the second, the blood is dark red and flows away in an uninterrupted stream. In the third, the blood oozes out. In some wounds all three kinds of bleeding occur at the same time.

The simplest and best remedy to stop the bleeding is to apply direct pressure on the external wound by the fingers. Should the wound be long and gaping, a compress of some soft material large enough to fill the cavity may be pressed into it; but this should always be avoided, if possible, as it prevents the natural closing of the wound.

Pressure with the hands will not suffice to restrain bleeding in severe cases for a great length of time and recourse must be had to a ligature; this can best be made with a pocket handkerchief or other article of apparel, long enough and strong enough to bind the limb. Fold the article neck-tie fashion, then place a smooth stone, or anything serving for a firm pad, on the artery, tie the handkerchief loosely, insert any available stick in the loop and proceed to twist it, as if wringing a towel, until just tight enough to stop the flow. Examine the wound from time to time, lessen the compression if it becomes very cold or purple, or tighten up the handkerchief if it commences bleeding.

Some knowledge of anatomy is necessary to guide the operator where to press. Bleeding from the head and upper neck requires pressure to be placed on the large artery which passes up beside the windpipe and just above the collar bone. The artery supplying the arm and hand runs down the inside of the upper arm, almost in line with the coat seam, and should be pressed as shown in Fig. 185. The artery feeding the leg and foot can be felt in the crease of the groin, just where the flesh of the thigh seems to meet the flesh of the abdomen and this is the best place to apply the ligature. In arterial bleeding the pressure must be put between the heart and the wound, while in venous bleeding it must be beyond the wound to stop the flow as it goes towards the heart.

In any case of bleeding, the person may become weak and faint; unless the blood is flowing actively this is not a serious sign, and the quiet condition of the faint often assists nature in staying the bleeding, by allowing the blood to clot and so block up any wound in a blood vessel. Unless the faint is prolonged or the patient is losing much blood, it is better not to hasten to relieve the faint condition; when in this state anything like excitement should be avoided, external warmth should be applied, the person covered with blankets, and bottles of hot water or hot bricks applied to the feet and arm-pits.

Frost-bite.—No warm air, warm water, or fire should be allowed near the frozen parts until the natural temperature is nearly restored; rub the affected parts gently with snow or snow water in a cold room; the circulation should be restored very slowly; and great care must be taken in the after treatment.

Broken Bones.—The treatment consists of, 1, carefully removing or cutting away, if more convenient, any of the clothes which are compressing or hurting the injured parts; 2, very gently replacing the bones in their natural position and shape, as nearly as possible, and putting the part in a position which gives most ease to the patient; 3, applying some temporary splint or appliance, which will keep the broken bones from moving about and tearing the flesh; for this purpose, pieces of wood, pasteboard, straw, or firmly folded cloth may be used, taking care to pad the splints with some soft material and not to apply them too tightly, while the splints may be tied by loops of rope, string, or strips of cloth; 4, conveying the patient home or to a hospital.

The bearer then places his arm behind the back of the patient and grasps his opposite hip, at the same time catching firmly hold of the hand of the patient resting on his shoulder, with his other hand; then by putting his hip behind the near hip of the patient, much support is given, and if necessary, the bearer can lift him off the ground and as it were, carry him along.

Poultices.—These outward applications are useful to relieve sudden cramps and pains due to severe injuries, sprains and colds. The secret of applying a mustard is to apply it hot and keep it so by frequent changes—if it gets cold and clammy it will do more harm than good. Poultices to be of any service and hold its heat should be from one-half to one inch thick. To make it, take flaxseed, oatmeal, rye meal, bread, or ground slippery elm; stir the meal slowly into a bowl of boiling water, until a thin and smooth dough is formed. To apply it, take a piece of old linen of the right size, fold it in the middle; spread the dough evenly on one half of the cloth and cover it with the other.

To make a “mustard paste” as it is called, mix one or two tablespoonfuls of mustard and the same of fine flour, with enough water to make the mixture an even paste; spread it neatly with a table knife on a piece of old linen, or even cotton cloth. Cover the face of the paste with a piece of thin muslin.

How to Carry an Injured Person.—In case of an injury where walking is impossible, and lying down is not absolutely necessary, the injured person may be seated in a chair, and carried; or he may sit upon a board, the ends of which are carried by two men, around whose necks he should place his arms so as to steady himself.

Where an injured person can walk he will get much help by putting his arms over the shoulders and round the necks of two others.

A seat may be made with four hands and the person may be thus carried and steadied by clasping his arms around the necks of his bearers.

If only one person is available and the patient can stand up, let him place one arm round the neck of the bearer, bringing his hand on and in front of the opposite shoulder of the bearer.

To get at a broken limb, or rib, the clothing must be removed, and it is essential that this be done without injury to the patient; the simplest plan is to rip up the seams of such garments as are in the way. Boots must be cut off. It is not imperatively necessary to do anything to a broken limb before the arrival of a doctor except to keep it perfectly at rest.

To carry an injured person by a stretcher (which can be made of a door, shutter, or settee—with blankets or shawls or coats for pillows) three persons are necessary. In lifting the patient on the stretcher it should be laid with its foot to his head, so that both are in the same straight line; then one or two persons should stand on each side of him, and raise him from the ground, slip him on the stretcher; this to avoid the necessity of any one stepping over the stretcher, and the liability of stumbling. If a limb is crushed or broken, it may be laid upon a pillow with bandages tied around the whole ( i.e., pillow and limb) to keep it from slipping about. In carrying the stretcher the bearers should “break step” with short paces; hurrying and jolting should be avoided and the stretcher should be carried so that the patient may be in plain sight of the bearers.