AMERICANREVOLUTION.ORG

DOMESTIC MEDICINE

CHAP. LIII.

OF CASUALTIES.

IT is certain that life, when to all appearance lost, may often, by due care, be restored. Accidents frequently prove fatal, merely because proper means are not used to counteract their effects. No person ought to be looked upon as killed by any accident, unless where the structure of the heart, brain, or some organ necessary to life, is evidently destroyed. The action of these organs may be so far impaired as even to be for some time imperceptible, when life is by no means gone: In this case, however, if the fluids be suffered to grow cold, it will be impossible to put them again in motion, even though the solids should recover their power of acting. Thus, when the motion of the lungs has been stopt by unwholesome vapour, the action of the heart by a stroke on the breast, or the functions of the brain by a blow on the head, if the person be suffered to grow cold, he will in all probability continue so; but, if the body be kept warm, as soon as the injured part has recovered its power of acting, the fluids will again begin to move, and all the vital functions will be restored.

IT is a horrid custom immediately to consign over to death every person who has the misfortune, by a fall, a blow, or the like, to be deprived of the appearance of life. This unhappy person, instead of being carried into a warm house, and laid by the fire, or put to a warm bed, is generally hurried away to church, or a barn, or some other cold damp house, where, after a fruitless attempt has been made to bleed him, perhaps by one who knew nothing of the matter, he is given over for dead, and no further notice taken of him. This conduct seems to be the result of ignorance, supported by an ancient superstitious notion, which forbids the body of any person killed by accident to be laid in an house that is inhabited. What the ground of this superistition may be, we shall not pretend to enquire; but surely the conduct founded upon it is contrary to all the principles of reason, humanity, and common sense.

WHEN a person seems to be suddenly deprived of life, our first business is to enquire into the cause. We ought carefully to observe whether any substance be lodged in the wind-pipe or gullet; and, if that is the case attempts must be made to remove it. When unwholesome air is the cause, the patient ought immediately to be removed out of it. If the circulation be suddenly stopped, from any cause whatever, except mere weakness, the patient should be bled. If the blood does not flow, he may be immersed in warm water, or rubbed with warm cloths, &c. to promote the circulation. When the cause cannot be suddenly removed, our great aim must be to keep up the vital warmth, by rubbing the patient with hot cloths, or salt, and covering his body with warm sand, ashes, or the like.

I SHOULD now proceed to treat more fully of those accidents, which, without immediate assistance, would often prove fatal, and to point out the most likely means for relieving the unhappy sufferers; but as I have been happily anticipated in this part of my subject by the learned and humane Dr. Tissot, I shall content myself with selecting such of his observations as seem to be the most important, and adding such of my own as have occurred in the course of practice.

OF SUBSTANCES STOPT BETWEEN THE MOUTH AND STOMACH.

THOUGH accidents of this kind are very common, and extremely dangrous, yet they are generally the effect of carelessness. Children should be taught to chew their food well, and to put nothing into their mouths which it would be dangerous for them to swallow. But children are not the only persons guilty of this piece of imprudence. I know many adults who put pins, nails, and other sharp-pointed substances in their mouths upon every occasion, and some who even sleep with the former there all night. This conduct is exceedingly injudicious, as a fit of coughing, or twenty other accidents, may force over the substance before the person is aware. A woman in one of the hospitals of this city lately discharged a great number of pins, which she had swallowed in the course of her business, through an ulcer in her side.

WHEN any substance is detained in the gullet, there are two ways of removing it, viz. either by extracting it or pushing it down. The safest and most certain way is to extract it: but this is not always the easiest; it may therefore be more eligible sometimes to thrust it down, especially when the obstructing body is of such a nature, that there is no danger from its reception into the stomach. The substances which may be pushed down without danger are, all common nourishing ones, as bread, flesh, fruits, and the like: All indigestible bodies, as cork, wood, bones, pieces of metal, and such like, ought if possible, to be extracted, especially if these bodies be sharp pointed, as pins, needles, fish-bones, bits of glass, &c.

WHEN such substances have not passed in too deep, we should endeavour to extract them with our fingers, which method often succeeds. When they are lower, we must make use of nippers, or a small pair of forceps, such as surgeons use. But this attempt to extract rarely succeeds, if the substance be of a flexible nature, and has descended far into the gullet.

IF the fingers and nippers fail, or cannot be duly applied, crotchets, a kind of hooks, must be employed. These may be made at once, by bending a piece of pretty strong iron wire at one end. It must be introduced in the flat way, and for the better conducting it, there should likewise be a curve or bending at the end it is held by, to serve as a kind of handle to it, which has this further use, that it may be secured by a string tied to it, a circumstance not to be omitted in any instrument employed on such occasions, to avoid such ill accidents as have some times ensued from these instruments slipping out of the operator's hand. After the crotchet has passed below the substance that obstructs the passage, it is drawn up again, and hooks up the body along with it. The crotchet is also very convenient, when a substance somewhat flexible, as a pin or fish-bone, sticks across the gullet, the hook, in such cases, seizing them about their middle part, crooks and thus disengages them; or, if they are very brittle substances, serves to break them.

WHEN the obstructing bodies are small, and only stop a part of the passage, and which may either easily elude the hook, or straiten it by their resistance, a kind of rings, made either of wire, wool, or silk, may be used. A piece of fine wire of a proper length may be bent into a circle, about the middle, of about an inch diameter, and the long unbent sides brought parallel, and near each other these are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be conducted about the obstructing body, and so to extract it. More flexible rings may be made of wool, thread, silk, or small pack-thread, which may be waxed for their greater strength and consistence. One of these is to be tied fast to a handle of iron wire, whale-bone, or any kind of flexible wood, and by this means introduced, in order to surround the obstructing substance, and to draw it out. Several of these rings passed through one another may be used, the more certainly to lay hold of the obstructing body, which may be involved by one, if another should miss it. These rings have one advantage, which is, that when the substance to be extracted is once laid hold of, it may then, by turning the handle, be retained so strongly in the ring thus twisted, as to be moved every way, which must in many cases be a considerable advantage.

ANOTHER material employed on these unhappy occasions, is the sponge. Its property of swelling considerably on being wet, is the principal foundation of its usefulness here. If any substance is stopt in the gullet, but without filling up the whole passage, a bit of sponge may be introduced into that part which is unstopt, and beyond the substance. The sponge soon dilates, and grows larger in this moist situation, and indeed the enlargement of it may be forwarded by making the patient swallow a few drops drops of water. Afterwards it is to be drawn back by the handle to which it is fastened; and as it is now too large to return through the small cavity by which it was conveyed in, it draws out the obstructing body along with it.

THE compressibility of sponge is another foundation of its usefulness in such cases. A pretty large piece of sponge may be compressed or squeezed into a small size, by winding a string of tape closely about it, which may be easily unwound, and withdrawn, After the sponge has been introduced. A bit of sponge may likewise be compressed by a piece of whale-bone split at one end, but this can hardly be introduced in such a manner as not to hurt the patient.

I HAVE often known pins and other sharp bodies which had stuck in the throat, brought up by causing the person to swallow a bit of tough meat tied to a thread, and drawing it quickly up again. This is safer than swallowing a sponge, and will often answer the purpose equally well.

WHEN all these methods prove unsuccessful, there remains one more, which is, to make the patient vomit: but this can scarcely be of any service, unless when such obstructing bodies are simply engaged in, and not hooked or stuck into the sides of the gullet, as in this case vomiting might sometimes occasion further mischief. If the patient can swallow, vomiting, may be excited by taking half a drachm or two scruples of ipecacuanha in powder made into a draught, if he is not able to swallow, an attempt may be made to excite vomiting, by tickling his throat with a feather; and if that should not succeed, a clyster of tobacco may be administered. It is made by boiling an ounce of tobacco in a sufficient quantity of water; this has often been found to succeed, when other attempts to excite vomiting had failed.

WHEN the obstructing body is of such a nature, that it may with safety be pushed downwards, this may be attempted by means of a wax-candle oiled, and a little heated, so as to make it flexible; or a piece of whale-bone, wire, or flexible wood, with a sponge fastened to one end.

SHOULD it be impossible to extract even those bodies which it is dangerous to admit into the stomach, we must then prefer the least of two evils, and rather run the hazard of pushing them down, than suffer the patient to perish in a few minutes; and we ought to scruple this resolution the less, as a great many instances have happened, where the swallowing of such hurtful and indigestible substances has been followed by no disorder.

WHENEVER it is manifest, that all endeavours either to extract or push down the substance, must prove ineffectual, they should be discontinued; because the inflammation occasioned by persisting in them might be as dangerous as the obstruction itself. Some have died in consequence of the inflammnation, even after the body which caused the obstruction had been entirely removed.

WHILE the means recommended above are making use of, the patient should often swallow, or if he can not, he should frequently receive by injection, through a crooked tube or pipe that may reach down to the gullet, some emollient liquor, as warm milk and water, barley-water, or a decoction of mallows. Injections of this kind not only soften and sooth the irritated parts, but, when thrown in with force, are often more successful in loosening the obstruction, than all attempts with instruments.

WHEN, after all our endeavours, we are obliged to leave the obstructing body in the part, the patient must be treated as if he had an inflammatory disease. He should be bled, kept upon a low diet, and have his whole neck surrounded with emollient poultices. The like treatment must also be used, if there be any reason to suspect an inflammation of the passages, though the obstructing body be removed.

A PROPER degree of agitation has sometimes loosened the inhering body more effectually than instruments. Thus, a blow on the back has often forced up a substance which stuck in the gullet; but this is still more proper and efficacious when the substance gets into the wind-pipe. In this case, vomiting and sneezing are likewise to be excited. Pins, which stuck in the gullet, have been frequently discharged by riding on horseback, or in a carriage.

WHEN any indigestible substance has been forced down into the stomach, the patient should use a very mild and smooth diet, consisting chiefly of fruits and
farinaceous substances, as puddings, pottage, and soups. He should avoid all heating and irritating things, as wine, punch, pepper, and such like; and his drink should be milk and water, barley-water, or whey.

WHEN the gullet is so strongly and fully closed, that the patient can receive no food by the mouth, he must be nourished by clysters of soup, jelly, and the like.

WHEN the patient is in danger of being immediately suffocated, and all hope of freeing the passage is vanished, so that death seems at hand, if respiration be not restored; the operation of bronchotomy, or opening of the wind-pipe, must be directly performed. As this operation is neither difficult to an expert surgeon, nor very painful to the patient, and is often the only method which can be taken to preserve life in these emergencies, we thought proper to mention it, though it should only be attempted by persons skilled in surgery.

OF DROWNED PERSONS.

WHEN a person has remained above a quarter of an hour under water there can be no considerable hopes of his recovery. But as several circumstances may happen to have continued life, in such an unfortunate situation, beyond the ordinary term, we should never too soon resign the unhappy object to his fate, but try every method for his relief, as there are many well attended proofs of the recovery of persons to life and health who had been taken out of the water apparently dead, and who remained a considerable time without exhitbiting any signs of life.

THE first thing to be done, after the body is taken out of the water, is to convey it, as soon as possible, to some convenient place where the necessary operations for its recovery may be performed. In doing this, care must be taken not to bruise or injure the body by carrying it in any unnatural posture with the head downwards, or the like. If an adult body, it ought to be laid on a bed, or on straw, with the head a little raised, and carried on a cart or on men's shoulders, and kept in as natural and easy a position as possible. A small body may be carried in the arms.

IN attempting to recover persons apparently drowned, the principal intention to be pursued is, to restore the natural warmth, upon which all the vital functions depend; and to excite these functions by the application of stimulants, not only to the skin, but likewise to the lungs, intestines, &c.

THOUGH cold was by no means the cause of the person's death, yet it will prove an effectual obstacle to his recovery. For this reason, after stripping him of his wet cloths, his body must be strongly rubbed for a considerable time with coarse linen cloths, as warm as they can be made; and, as soon as a well heated bed can be got ready, he may be laid in it, and the rubbing should be continued. Warm cloths ought likewise to be frequently applied to the stomach and bowels, and hot bricks, or bottles of warm water, to the soles of his feet, and to the palms of his hands.

STRONG volatile spirits should be frequently applied to the nose; and the spine of the back and pit of the stomach may be rubbed with warm brandy or spirit of wine. The temples ought always to be chafed with volatile spirits; and stimulating powders, as that of tobacco or marjoram, may be blown up the nostrils.

TO renew the breathing, a strong person may blow his own breath into the patient's mouth with all the force he can, holding his nostrils at the same time. When it can be perceived by the rising of the chest or belly that the lungs are filled with air, the person ought to desist from blowing, and should press the breast and belly so as to expel the air again; and this operation may be repeated for some time, alternately inflating and depressing the lungs so as to imitate natural respiration.

IF the lungs cannot be inflated in this manner, it may be attempted by blowing through one of the nostrils, and at the same time keeping the other close. Dr. Monro for this purpose recommends a wooden pipe fitted at one end for filling the nostril, and at the other for being blown into by a person's mouth, or for receiving the pipe of a pair of bellows, to be employed for the same purpose, if necessary.

WHEN air cannot be forced into the chest by the mouth or nose, it may be necessary to make an opening into the windpipe for this purpose. It is needless, however, to spend time in describing this operation, as it should not be attempted unless by persons skilled in surgery.

TO stimulate the intestines, the fume of tobacco may be thrown up in form of clyster. There are various pieces of apparatus contrived for this purpose, which may be used when at hand; but where these cannot be obtained, the business may be done by a common tobacco-pipe. The bowl of the pipe must be filled with tobacco well kindled, and, after the small tube his been introduced into the fundament, the smoke may be forced up by blowing through a piece of paper full of holes wrapped round the mouth of the pipe, or by blowing through an empty pipe, the mouth of which is applied close to that of the other. This may also be done in the following manner: A common clyster-pipe with a bag mounted upon it may be introduced into the fundament, and the mouth of the bag may be applied round the small end of a tobacco-pipe, in the bowl of which tobacco is to be kindled, and the smoke blown up as directed above. Should it be found impracticable to throw up the smoke of tobacco, clysters of warm water, with the addition of a little salt and some wine or spirits, may be frequently administered. This may be done by a common clyster bag and pipe: but, as it ought to be thrown well up, a pretty large syringe will answer the purpose better.

WHILE these things are doing, some of the attendants ought to be preparing a warm bath, into which the person should be put, if the above endeavours prove ineffectual. Where there are no conveniencies for using the warm bath, the body may be covered with warm salt, sand, ashes, grains, or such like. Tissot mentions an instance of a girl who was restored to life, after she had been taken out of the water, swelled, bloated, and to all appearance dead, by laying her naked body upon hot ashes, covering her with others equally hot, putting a bonnet round her head, and a stocking round her neck stuffed with the same, and heaping coverings over all. After she had remained half an hour in this situation, her pulse returned, she recovered speech, and cried out I freeze, I freeze; a little cherry brandy was given her, and she remained buried as it were under the ashes for eight hours; afterwards she was taken out, without any other complaint except that of lassitude or weariness, which went off in a few days. The Doctor mentions likewise an instance of a man who was restored to life, after he had remained six hours under water, by the heat of a dunghill.

TILL the patient shews some signs of life, and is able to swallow, it would be useless and even dangerous to pour liquors into his mouth. His lips, however, and tongue, may be frequently wet with a feather dipt in warm brandy or other strong spirits; and as soon as he has recovered the power of swallowing, a little warm wine, or some other cordial, ought every now and then to be administered.

SOME recommend a vomit after the patient is a little re-animated, but if he can be made to puke without the sickening draught, it will be more safe; this may generally be done by tickling the throat and fauces with an oiled feather, or some other soft substance, which will not injure the parts. Tissot in this case recommends the oxymel of squills, a table-fpoonful of which, diluted with water, may be given every quarter of an hour, till the patient has taken five or six doses. Where that medicine is not at hand, a strong infusion of sage, camomile flowers, or carduus benedictus, sweetened with honey, or some warm water, with the addition of a little salt, may, he says, supply its place. The Doctor does not intend that any of these things should be given in such quantity as to occasion vomiting. He thinks emetics in this situation are not expedient.

WE are by no means to discontinue our assistance as soon as the patients discover some tokens of life, since they sometimes expire after these first appearances of recovering. The warm and stimulating applications are still to be continued, and small quantities of some cordial liquor ought frequently to be administered. Lastly, though the person should be manifestly re-animated, there sometimes remain an oppression, a cough, and feverishness, which effectually constitute a disease. In this case it will be necessary to bleed the patient in the arm, and to cause him to drink plentifully of barley-water, elder-flower tea, or any other soft pectoral infusions.

SUCH persons as have the misfortune to be deprived of the appearances of life, by a fall, a blow, sufflocation, or the like, must be treated nearly in the same manner as those who have been for some time under water. I once attended a patient who was so stunned by a fall from a horse, that for above six hours he scarcely exhibited any signs of life; yet this man, by being bled, and proper methods taken to keep up the vital warmth, recovered, and in a few days was perfectly well. Dr. Alexander gives an instance to the same purpose, in the Edinburgh Physical and Literary Essays, of a man who was to all appearance killed by a blow on the breast, but recovered upon being immersed for some time in warm water. These and other instances, of a similar nature, which might be adduced, amount to a full proof of this fact, that many of those unhappy persons who lose their lives by falls, blows, and other accidents, might be saved by the use of proper means duly persisted in.

OF NOXIOUS VAPOURS.

AIR may be many ways rendered noxious, or even destructive to animals. This may either happen from its vivifying principle being destroyed, or from subtle exhalations with which it is impregnated. Thus air that has passed through burning fuel is neither capable of supporting fire nor the life of animals. Hence the danger of sleeping in close chambers with charcoal fires. Some indeed suppose the danger here proceeds from the sulphureous oil contained in the charcoal, which is set at liberty and diffused all over the chamber; while others imagine it is owing to the air of the room being charged with phlogiston. Be this as it may, it is a situation carefully to be avoided. Indeed, it is dangerous to sleep in a small apartment with a fire of any kind. I lately saw four persons who had been suffocated by sleeping in an apartment where a small fire of coal had been left burning

THE vapour which exhales from wine, cyder, beer, or other liquors, in the state of fermentation, contains something poisonous, which kills in the same manner as the vapour of coal. Hence there is always danger in going into cellars where a large quantity of these liquors is in a state of fermentation, especially if they have been close shut up for some time. There have been many instances of persons struck dead on entering such places and of others who have with difficulty escaped.

WHEN subterraneous caves that have been very long shut, are opened, or when deep wells are cleaned, which have not been emptied for several years, the vapours arising from them produce the same effects as those mentioned above. For this reason, no person ought to venture into a well, pit, cellar, or any place that is damp, and has been long shut up, till the air has been sufficiently purified, by burning gunpowder in it. It is easy to know, as has been observed in a former part of this work, when the air of such places is unwholesome, by letting down a lighted candle, throwing in burning fuel, or the like. If these continue to burn, people may safely venture in; but where they are suddenly extinguished, no one ought to enter till the air has been first purified by fire.

THE offensive stink of lamps and of candles, especially when their flames are extinguished, operate like other vapours, though with less violence, and less suddenly. There have however, been instances of people killed by the fumes of lamps which had been extinguished in a close chamber, and persons of weak delicate breasts generally find themselves quickly oppressed in apartments illuminated with many candles.

SUCH as are sensible of their danger in these situations, and retreat seasonably from it, are generally relieved as soon as they get into the open air, or, if they have any remaining uneasiness, a little water and vinegar, or lemonade, drank hot, affords them relief. But when they are so far poisoned, as to have lost their feeling and understanding, the following means must be used for their recovery:

THE patient should be exposed to a very pure, fresh, and open air; and volatile salts, or other stimulating substances, held to his nose. He should next be bled in the arm, or if that does not succeed, in the neck. His legs ought to be put into warm water, and well rubbed. As soon as he can swallow, some lemonade, or water and vinegar, with the addition of a little nitre, may be given him.

NOR are sharp clysters by any means to be neglected; these may be made, by adding to the common clyster, syrup of buckthorn and tincture of senna, of each two ounces; or, in their stead, half an ounce of Venice turpentine dissolved in the yolk of an egg. Should these things not be at hand, two or three large spoonfuls of common salt may be put into the clyster. The same means, if necessary, which were recommended in the former part of this chapter, may be used to restore the circulation, warmth, &c.

MR. TOSSACH, surgeon at Alloa, relates the case of a man suffocated by the steam of burning coal, whom he recovered by blowing his breath into the patient's mouth, bleeding him in the arm, and causing him to be well rubbed and tossed about. And Dr. Frewen, of Sussex, mentions the case of a young man who was stupified by the smoke of sea-coal, but was recovered by being plunged into cold water, and afterwards laid in a warm bed.

THE practice of plunging persons suffocated by noxious vapours in cold water, would seem to be supported by the common experiment of suffocating dogs in the grotto del cani, and afterwards recovering them, by throwing them into the neighbouring lake.

EFFECTS OF EXTREME COLD.

WHEN cold is extremely severe, and a person is exposed to it for a long time, it proves mortal, in consequence of its stopping the circulation in the extremities, and forcing too great a proportion of blood towards the brain; so that the patient dies of a kind of appoplexy; preceded by great sleepiness. The traveller, in this situation, who finds himself begin to grow drowsy, should redouble his efforts to extricate himself from the imminent danger be is exposed to. This sleep, which he might consider as some alleviation of his sufferings, would, if indulged, prove his last.

SUCH violent effects of cold are happily not very common in this country; it frequently happens, however, that the hands or feet of travellers are so benumbed or frozen, as to be in danger of a mortification, if proper means are not used to prevent if. The chief danger in this situation arises from the sudden application of heat. It is very common, when the hands or feet are pinched with cold, to hold them to the fire; yet reason and observation shew that this is a most dangerous and imprudent practice.

EVERY peasant knows, if frozen meat, fruits, or roots of any kind, be brought near the fire, or put into warm water, they will be destroyed, by rottenness, or a kind of mortification; and that the only way to recover them, is to immerse them for some time in very cold water. The same observation holds with regard to animals in this condition.

WHEN the hands or feet are greatly benumbed with cold, they ought either to be immersed in cold water, or rubbed with snow, till they recover their natural warmth and sensibility: after which the person may be removed into an apartment a little warmer, and may drink some cups of tea, or an infusion of elder flowers sweetened with honey. Every person must have observed, when his hands were even but slightly affected with cold, that the best way to warm them was by washing them in cold water, and continuing to rub them well for some time.

WHEN a person has been so long exposed to the cold, that all appearances of life are gone, it will be necessary to rub him all over with snow or cold water; or, what will answer better, if it can be obtained, to immerse him in a bath of the very coldest water. There is the greatest encouragement to persist in the use of these means, as we are assured that persons who had remained in the snow, or had been exposed to the freezing air during five or six successive days, and who had discovered no marks of life for several hours, have nevertheless been revived.

I HAVE always thought, that the whitloes, kibes, chilblains, and other inflammations of the extremities, which are so common among the peasants in the cold season, were chiefly occasioned by their sudden transitions from cold to heat. After they have been exposed to an extreme degree of cold, they immediately apply their hands and feet to the fire, or, if they have occasion, plunge them into warm water, by which means, if a mortification does not happen, an inflammation seldom fails to ensue. Most of the ill consequences from this quarter might be easily avoided, by only observing the precautions mentioned above.

EFFECTS OF EXTREME HEAT.

THE effects of extreme heat, though not so common in this country, are no less fatal, and much more sudden than those of cold. In hot countries people frequently drop down dead in the streets, exhausted with heat and fatigue. In this case, if any warm cordial can be poured into the mouth it ought to be done. If this cannot be effected, they may be thrown up in form of a clyster. Volatile spirits, and other things of a stimulating nature, may be applied to the skin, which should be well rubbed with coarse cloths, whipped with nettles, or other stimulating things. Some of the ancient physicians are said to have restored to life, persons apparently dead, by beating them with rods.

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