In this chapter we wish to instruct the mother or the caretaker in doing the one thing needful for every one of the more common household accidents and emergencies while waiting for the doctor.

In every household there should be found an accident and emergency "kit" of necessary paraphernalia for the quick application of the one necessary medicine, dressing, etc. This "kit" should contain baking soda for burns, bandages and sterile gauze for cuts or tears, together with adhesive plaster, needle and thread, etc.

INSECT BITES AND STINGS

Far greater harm is often done the skin by the subsequent scratching of the insect bite with dirty finger nails than by the bite itself; and so it is very important that we remember to allay quickly the intense itching by the application of ammonia, water or camphor. Almost instantly the itching is stopped, and the added "scratching" irritation to the already injured skin is thus avoided.

By the aid of a magnifying glass, and often by the naked eye, we may detect the stinger which has been left behind by the greedy guest, and which should be removed by a pair of tweezers. Ice-water compresses will stop the swelling and even an old-fashioned mud dressing, which was used and appreciated by our great grandmothers, is a thing not to be despised.

If the much admired shrubbery be removed one hundred feet away from the porch, mosquitoes would trouble the household less. It has been demonstrated in many localities that clearing away the near-by clumps of shrubbery permits the family to sit on unscreened porches unharmed. Mosquitoes multiply rapidly in stagnant pools of water, but if oil is poured over these stagnant waters the increase of mosquitoes is abated, and their total extinction is not unheard of in swampy districts receiving such care.

Whenever baby is out of doors where mosquitoes, flies, or other insects are to be found, he should be properly protected from such pests by mosquito netting stretched over a frame eighteen inches above his face, for we can think of nothing more uncomfortable than a mosquito netting dragging over a sweaty baby's face. The fact that mosquitoes, flies, roaches, and other insects are carriers of tuberculosis, infantile paralysis, typhoid fever, cholera, yellow fever and malaria, as well as a host of minor ailments, should make us the more anxious for either their extermination or the protection of our children from their greedy bites and stings.

DOG BITES AND SNAKE BITES

Dogs, cats, rats, or mice bite at any time of the year, and provision should always be made for ample protection against such accidents.

Such a wound should always be squeezed or sucked until it has bled freely, and then be cauterized by a red-hot iron or touched with an applicator that has been dipped in sulphuric acid or nitric acid. A subsequent dressing of Balsam Peru is healing. The dog should be watched, and if it shows signs of hydrophobia the bitten child should be promptly taken to the nearest Pasteur Institute for treatment.

In the case of snake bites the same sucking and cauterizing treatment is indicated, with the additional tying of a handkerchief or cord a few inches above the wound to stay the progress of the blood and to keep the poison out of the general circulation. A solution of twenty-per-cent permanganate of potash should be used to wash the wound.

The popular administration of large draughts of whiskey is of no benefit, for the secondary depressant effect of alcohol increases the body's poison burden, and those who survive do so in spite of the whiskey, and not because of it.

SWALLOWING FOREIGN BODIES

Small articles such as buttons, safety pins, thimbles, coins, etc., are often swallowed by little folks, and if they lodge in the throat and the child struggles for his breath the treatment is as follows: grasp him by the heels and turn him upside down while a helper briskly slaps him on the back. The foreign body generally flies across the room. If it is lodged high up in the throat it may often be dislodged by the thumb and finger. If it cannot be reached and it will not go down, lose no time in seeking an X-ray laboratory where its exact location may quickly be discovered and proper measures instituted for its removal.

A troublesome fish bone is easily dislodged by swallowing a half-chewed piece of bread which carries it down to the stomach. Cathartics and purgatives are not to be given; in due time the object will appear in the stool. In all instances it is well to locate its exact position by the X ray—that there may be assurance that it will do no harm.

It is surprising what large objects can be swallowed. One old gentleman swallowed his false teeth, and a six months old baby swallowed, or at least had lodged in its throat, a silver dollar.

All detachable parts should be removed from toys that are given to babies, such as the whistle from rubber animals, the button eyes of wool kittens and dogs, and other such removable parts.

FOREIGN BODIES IN THE EYE

To begin with, do not get "panicky," but carefully, painstakingly, and patiently do the following:

1. Rub the well eye until the tears flow plentifully in both eyes.

2. Blow the nose on the injured eye side, closing the other side. This often encourages the tears to wash the foreign speck down through the tear duct, into the nose and out into the handkerchief (in case the child is old enough to follow such instruction). If the foreign body be sharp, as a piece of steel or flint is likely to be, it may be driven right into the eyeball. Seek a physician who will drop medicine into the eye to deaden the pain and then if it cannot be gently rubbed off the eyeball, a magnet will promptly remove it.

An eye bath of warm boracic acid is always comforting and never does harm, so that may be given while waiting for the doctor to come, if the object seems to be beyond the reach of family help.

If an alkaline, such as lime, be blown into the eye it is very painful, but much relief may be obtained by gently pouring into the eye, by means of a medicine dropper or eye cup, warm water to which has been added a little vinegar or lemon juice. Likewise, acid in the eye produces much pain. In this instance, an eye bath of a weak soda solution is indicated.

FOREIGN BODIES IN EAR AND NOSE

Insects that have crawled into the ear may be suffocated by dropping sweet oil or castor oil into the ear, which, after twenty minutes, should be washed out by gentle syringing with warm water from a fountain syringe, hung one foot above the child's head.

Peas, beans, shoe buttons, or beads are sometimes put into the ear and nose by adventurous or experimenting children.

The shoe button or bead will not swell as does the pea or the bean, and may often be safely washed out. If it is causing no pain and will not drop out in case of the ear, or will not be easily blown out in case of the nose, see your physician at once. He has in his possession just the necessary instruments for its immediate removal.

Peas and beans swell, and consequently cause greater discomfort the longer they are in; do not poke at any foreign body lodged either in the nose or the ear, for the ear drum may thus be injured, while in the former case it may be pushed into one of the accessory sinuses.

EARACHE

One of the most comforting and highly effectual forms of heat for an aching ear is a four-candle-power carbon electric light on an extension cord that permits the light to come in close contact with the ear. A shade is made from a piece of stiff letter paper that fits the socket snugly and flares out to a three inch opening, which should extend below the point of the bulb one inch. This shade holds all the heat and light and directs it into the aching ear.

In every well-ordered household there will be found a three-per-cent solution of carbolic acid and glycerine of which one drop should be put into the aching ear, and then the external heat, mentioned above, should be applied. A bag of warm salt, a hot water bag, or a warm plate will provide external heat if an electric light is not available. Do not put laudanum or other remedies into the ear, other than are herein suggested, without your physician's knowledge.

Earache is always serious, and since it is usually indicative of trouble which, if left untreated, may cause deafness, it demands thorough treatment from skilled hands.

Running ears invariably need medical attention and should never be neglected.

NOSEBLEED

If the nose bleeds whenever it is cleansed, more than likely there is an ulcer on the septum which will continue to bleed if left untreated. The physician should heal the ulcer, and the child should be taught always to vaseline the nostril before cleansing it.

In case of persistent nosebleed, put the child to bed with the head elevated. Pressure should be put on the blood vessels going to the nose by placing two fingers firmly on the outer angles of the nose on the upper lip, while a helper may put firm pressure at the root of the nose at the inner angle of each eye. An ice bag may be placed at the back of the neck, and another piece of ice held on the forehead at the root of the nose. If these measures do not stop the flow of blood a few drops of adrenalin may be put into the nose and repeated in five minutes if necessary. As the bleeding begins to stop, as well as during the bleeding, all blowing of the nose is forbidden as it will only cause the bleeding to start afresh. It sometimes helps to hold a piece of ice in the hands.

CUTS AND TEARS

A cut with smooth edges, if deep, should be allowed to bleed freely, should be washed in boracic acid solution, and its edges held together by a stitch which is usually put in by a physician; but if treatment is to be given at home, the hands of the nurse must be thoroughly washed and the thread and needle boiled for twenty minutes. If the physician has been sent for, make firm pressure over the wound by bandaging tightly with a dressing of sterile gauze dipped in boracic acid solution.

In case of a slight cut, make it bleed freely, then wash in boracic-acid solution and apply sterile gauze held in place by a binder. If no odor or pain follows, let alone for two or three days, when a new dressing is applied.

A physician should be called in case of ragged wounds or tears, as such usually leave bad scars. Cleanse carefully, leaving no dirt in the wound, cause it to bleed, if possible, and apply a sterile gauze compress wet in boracic-acid solution, bandaged on as directed above. Zinc ointment may be applied to surfaces that have been skinned. All dressings on dirty wounds should be changed daily.

Blood poisoning may readily follow a wound, hence the utmost cleanliness should prevail. The hands of the attendant, the dressings, the surrounding skin, must all be clean. The bowels should be kept open, and under-feeding rather than over-feeding is indicated.

If a needle be needed to open a sore or boil, always disinfect the part and surrounding area by painting with tincture of iodine, and heat the needle to red heat through a flame before it touches the sore.

In case of cuts or wounds of the eyeball apply a compress of sterile gauze wet in boracic acid, held on by a bandage, and go immediately to a good eye specialist.

PUNCTURED WOUNDS AND SLIVERS

Wounds made by pins, needles, fishhooks, tacks, and splinters are always very painful and great care must be exercised to force bleeding freely, which helps to wash out infection, as more than likely microbes entered with the instrument or sliver when the wound was made.

Fishhooks are exceedingly troublesome, as they often occasion the enlarging of the wound to get them out, especially if they have gone in beyond the barb.

Slivers are easily broken off, so great care is needed in their removal. A pair of tweezers is convenient for seizing the protruding portion, while all side movements are avoided lest it break off in the flesh, in which case it may be gotten out with a needle that has been sterilized in a flame.

All puncture wounds should be dressed with the wet, sterile compress, covered over with wax paper and bandaged loosely; this encourages cleanliness and favors healing.

BRUISES

If left untreated, bruises swell, become highly discolored, and in the process of healing pass through the dark blue, green, and yellow stages. The treatment is as follows: Apply hot and cold alternately—the heat should be as hot as can be borne and left on very hot for three minutes, then ice water compresses should be applied for one minute, then hot again—these changes should continue for an hour, and if carried out immediately after the injury all discolorations and most of the swelling may be avoided. Witch-hazel compresses are comforting. If discoloration has taken place, the application of hot compresses will often hasten its disappearance.

FRACTURES AND DISLOCATIONS

While there is very little a member of the family or a non-medical friend can do in case of a fracture, and while it is unwise to offer suggestions relative to the setting of bones, yet it is highly important that both the family and friends know how properly to support a broken leg while carrying a disabled person into the house or to near-by medical aid.

For instance, in the case of a fractured leg below the knee, if a couple of flat boards three inches wide be tied about the leg with two pocket handkerchiefs, the ends of the fractured bone will not rub against each other and the pain will be much less in carrying. In this way all danger of causing the broken bones to protrude and thus "compounding" the fracture is also avoided. And also, if there is no near-by ambulance, a good emergency stretcher may be improvised out of two or three buttoned vests with two poles, rakes, or brooms run through the armholes—one vest under the shoulders and one under the hips and still another under the fracture. An injured person may in this way be carried for miles quite comfortably.

Two people may fashion a seat out of their four hands on which the disabled child may sit with his arms about the necks of his two friends. If the fractured end of the bone penetrates the flesh it is then known as a compound fracture and the utmost cleanliness must prevail—as in dressing other wounds. An X ray laboratory should always be sought, where convenient, to ascertain if the ends of the bones are in good position.

In dislocations, the bone has slipped out of place at the joint. Medical aid should be called to replace the bone, while hot applications may be used in the meantime.

SPRAINS

All sprains (a twist or straining of a joint) should promptly be put into a very hot bath and held there for thirty minutes. If this is impossible, then a rubber tube or a handkerchief is tied snugly between the sprain and the trunk of the body. Almost instantly the pain, which is often intense and severe, is very much lessened. The hot-water bath is very hot, and the joint should be very red on taking it out. Immediately following the bath the injured joint is wrapped in a very cold wet compress, which is next completely covered by silk, gutta-percha, mackintosh, or many thicknesses of newspaper—anything that will hold all the heat in—as the cold compress is quickly heated up. Lastly, a bandage of heavy flannel completely covers the whole—compress, impervious covering, etc.

The joint is now elevated for three hours, when it is again immersed in a very hot bath and then again the cold compress is applied. This is continued every three hours, except during sleep, for two days, after which it may be done morning and evening. Massage is now administered every three hours, first four inches below the injury then four inches above it, while in a day or so the joint itself may be gently rubbed with well-oiled hands. By the end of one week the patient begins to use the injured member.

In the case of a sprained ankle a properly applied adhesive strap bandage will give no end of relief and support. Various liniments may be applied, but usually the good obtained is from the thorough rubbing which always accompanies their use according to directions.

Sprains treated as above directed will often liberate the child in one-third the usual time generally allotted for its healing.

FROST BITES AND CHILBLAINS

Keep the child who has frozen some part of his body in a cool room, and rub the frost-bitten part with snow or ice water, or wrap it up in cold water compresses.

The return to heat must be slow indeed, else much pain may be experienced; blisters followed by discoloration, and even mortification, may set in. You may be surprised some morning on awakening to find your child's hand twice its normal size and very red, because it was out from under the cover a good share of the night exposed to Jack Frost. Do not bring it to heat quickly but immerse it in cold water, gradually and slowly raising the temperature of the bath until it is warm and comfortable.

The intense itching and burning of a chilblain may often be relieved by painting with iodine or triple chloride of iron (Monsel's solution). Soap liniment has also been suggested, as well as alternate applications of hot and cold water. Chilblains are troublesome, painful, and their yearly recurrence is often very annoying.

SWALLOWING POISONS

Poisons of an acid nature, such as hydrochloric, sulphuric, nitric, or oxalic acids, are neutralized by alkalines, such as magnesia, chalk, soda, and soap, followed by soothing drinks or sweet oil.

Remember that carbolic acid is not an acid, and is not antidoted with alkalines. The swallowing of carbolic acid should be quickly followed by diluted alcohol, and if this drug is not ready at hand many of the numerous alcoholic patent medicines will do just as well. Epsom salts should be given in abundance.

Poisons of an alkaline nature, such as lye, washing soda, ammonia, etc., are antidoted with vinegar or lemon juice, followed by soothing drinks or sweet oil.

A complete table of poisons and their antidotes will be found in the appendix.

Poison ivy, as soon as detected, should be treated as follows: Thoroughly scrub the affected part with tincture of green soap and hot water, which often prevents the trouble developing. Clean pieces of gauze may be wrung out of lime water and placed over the inflamed and much swollen surface, keeping them very wet. At night an ointment of zinc oxide may be applied over a painting of "black wash" (to be obtained at drug stores). Poison (trifoliolate, or three-leaved) ivy resembles Virginia Creeper, and all nurses and caretakers should be able to recognize it.

Another treatment for poison ivy which is said to be very efficient is as follows: Moisten a bit of cotton with a ten-percent solution of carbolic acid and apply to the affected area—then immediately (about one-half minute) wipe off this carbolic acid with another piece of cotton saturated with alcohol.

Matches, roach powders, fly poisons, washing fluids, lye, paris green, antiseptic tablets, and pieces of green paper, should all be kept out of the child's reach; and, in case of accidental swallowing of any of them, the physician should be sent for at once, and with the message "Come!" should be given the name of the poison swallowed—if it is known.

After the antidote is given, soothing drinks are usually administered, such as raw white of egg, milk, flaxseed tea, slippery elm, etc.

Complete rest in bed is always essential, and external heat is necessary for the body chills easily as the child grows weak.

Toothache may be temporarily relieved by applying an ice bag below the jaw, thus diminishing the flow of blood to the tooth, and a hot-water bottle to the cheek, which causes the skin vessels to fill with blood, thus relieving the tension in the vessels of the tooth.

If there is a cavity, a small piece of cotton moistened with oil of cloves and packed well into it may give much relief.

Children and adults should make a bi-annual pilgrimage to the dentist, who seeks out beginning cavities, early treatment of which will prevent these dreadful aches and later ill health.

BURNS

Burns and scalds are not at all uncommon with children, whose eagerness to explore and desire to investigate often leads them into trouble.

1. The simple reddening of the skin—slight burns and sunburn—simply needs protecting oil, or equal parts of oil and lime water, and is to be covered with sterile gauze.

2. The burns which destroy the outer layer of the skin, producing a blister, are treated much as a wound would be treated. The blister, if larger than a half dollar, should be opened near the edge with a needle which has been passed through a flame. The serum should be pressed out and the parts protected by a piece of gutta-percha that has been disinfected with some antiseptic solution; this covering keeps the dressings from sticking, thus avoiding the destruction of the new-forming tissues.

3. When the tissues are injured in the more severe burns, the surrounding flesh is carefully disinfected with boracic-acid solution, and the same dressing applied as described for the "blister burns." Balsam Peru is a healing balm for burns of this classification.

If a child's clothes catch on fire he is instantly to be thrown on the floor and any heavy woolen fabric, such as a curtain, table spread, blanket, or rug, is to be thrown over him (beginning at the neck) and the flames thus smothered. The clothing is now cut off, and if more than one-third of the body is burned the child should be taken to the hospital for constant care; and if more than one-half of the body is injured recovery is doubtful. Great care should be taken in keeping the unburned portion of the body warm, as there is a great tendency for the child to become very cold as he weakens from both the nervous shock and from the absorption of toxins.

Acid chemical burns are treated with baking soda, except in the case of carbolic acid (misnamed), which is treated with alcohol; alkaline chemical burns are dressed in vinegar or lemon juice compresses.

Methods for restoring the drowned should be understood by every man, woman, and youth. These methods are more fully taken up in works devoted to emergencies and will not be discussed in detail at this time.

FAINTING

Consciousness is quickly restored to the fainting child by lowering the head—laying him flat on the floor—while an assistant raises the legs perpendicularly. Cold dashes of water may be slapped on the chest with a towel, while the face is bathed or sprinkled with cold water. Consciousness is usually quickly restored by the above suggestions, in connection with plenty of fresh air.

A sudden blow on the head occasionally results in a severe condition known as concussion of the brain. There is a partial or complete loss of consciousness lasting from a few moments to an hour or two. Pallor of the skin and a sense of bewilderment accompany concussion of the brain.

Rest, quiet, and darkness should prevail until the physician arrives and makes an examination. External heat to the extremities may be applied, but no stimulants are to be administered until so ordered by the physician.

It is wise to seek medical advice in the case of odd or unusual behavior after a fall on the head.