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Hints for Emergencies, Issue 7982, 10 August 1889, Supplement
Hints for Emergencies
Sir W. Moore, late Surgeon-general with the Government of Bombay, has a paper in the ‘Hospital’ on ‘The Immediate Treatment of Accident and Sudden Illness,’ in which he states that only the other day he was passing Kensington Gardens, when he observed an old man being supported by two other persons, and encouraged to cling to the railings, so as to maintain an upright posture, A glance showed what was the matter with the old man. Ho had been struck by cardiac failure, or serous apoplexy, or that variety of the malady in which the face is pale, and the circulation of the blood failing. His pulse was feeble and intermittent, and there was evident paralysis on one side of the body. Now, what ought to have been done in such a case? The poor old man should have beeu laid on right side full length, his collar should have been opened, he should hsve been allowed plenty of fresh air, and bis legs, feet, and hands should have been well rubbed. Then when the first shock of the malady had passed away, ho ought to have been carried, still in the recumbent posture, to the nearest hospital. Again, another instance. Only a few days back, in the Hammersmith road, two boys were knocked down by a cab. One escaped with little injury, the other got concussion of the brain. He was almost senseless, speechless, cold, and pallid. The same plan ought to have been pursued as in the case of the old man ; but instead of this, the hoy was surrounded by a dense crowd of inquisitive people, and one good but mistaken Samaritan was supporting the injured youth in an upright position on his knee. After a time the poor boy was dragged away on his legs, being well shaken and jostled in the process. Yet a third instance. In Hyde Park, one recent Sunday, a person was taken in an epileptic fit. One bystander wisely ran for water ; others carried the epileptic to a bench, on which he was seated. Now, in epilepsy there is a great struggling, the limbs are convulsed, and the tongue is very liable to be protruded between the teeth and severely bitten. This accident should be guarded against by placing something, as a small piece of soft wood, too large to slip into the mouth, between the teeth ; and the person should be simply prevented injuring himself in his struggles until the fit passes away. But nothing of the kind was attempted ; the consequence being that the tongue was bitten, and tbe limbs of the epileptic were bruised against the hard wood of the bench on which he was seated and held. Had he been placed on the soft grass and left alone he would have injured himself less.
The following are rules which may be safely adopted in cases of accident and sudden illness. Place the person on the ground or floor lying toward the right side, and with the head raised to the level of the body by a pillow, folded coat, or other soft substance. Then unbutton or split open any clothing pressing upon the neck or chest. The face and chest should be sprinkled with cold water, and some cold water may be given to drink if the power of swallowing remains. Wine, brandy, or other liquor should not be hastily given without evidence of their being needed. Examine the head and limbs separately. The prominent parts of the limbs may be examined with very little movement of the body. If it is necessary to move a person after any injury, especially of the head, the person should be carried while lying down. He should not be allowed to sit upright in a vehicle or to walk. See that the person is allowed plenty of fresh air. The history of the accident should be obtained, and when sending for a surgeon the message should be as clear as possible, and, if practicable, a written one.
The most common maladies which occur suddenly to people in the streets of large towns are apoplectic and epileptic attacks, maladies depending on heart affections, and drunken fits, although, perhaps, the
latter should not bo classed under the head “ maladies.” But it is necessary to distinguish apoplexy and epilepsy from “ dead drunk,” as it is called, and also poisoning by opium. Apoplexy is known from epilepsy by the puffing or snoring breathing which occurs in the former malady. In epilepsy there is no struggling of the limbs, the eyes are turned up under the lids, so that the whites only are visible, and the person generally falls down with a loud cry, none of which are the symptoms of apoplexy, Apoplexy is to be distinguished from affections due to the heart, because in the latter maladies the symptoms are very similar to fainting. The person is pale, unconscious, with feeble pulse, scarcely perceptible breathing, white lips and a deathlike expression of countenance; while im apoplexy, though the person is unconscious, there is snoring or puffing breathing, an<s the face is often drawn to one s'de, Apoplexy is best distinguished from the effects of spirituous liquors by the history of the case, which may probably be one of drinking. Secondly, by the smell of liquor in the person’s breath ; although this is not a certain sign, for someone may, in mistaken kindness, have given the person struck with apoplexy some kind of liquor. Thirdly, in the “ drunken fit," the size of the pupils of the eyes is equal, while in apoplexy one is often larger than the other. By the pupils of the eyes is meant the round space in the centre of the dark part of the eye. Fourthly, the person “ dead drunk" m-.y generally be roused when ho babbles incoherently, while from apoplexy the person cannot be ronsed. Lastly, if any movements occur in drunkenness they will be of the limbs, whereas movement is usually restricted to one side of the body in apoplexy. From poisoning by opium apoplexy is best distinguished by the history of the case: by the smell of opium in the breath ; by both pupils of the eyes being very small and contracted ; by the fact that the patient may be roused, although he does not then babble as in the drunken fit, but immediately goes to sleep again.
If all that has been advanced cannot be held in recollection, the condensed rules may certainly be remembered—viz.: First, in all cases of accident or sudden illness let the person lie down, and do not assist him to maintain tbe upright posture ; secondly, let him have plenty of fresh air; thirdly, unloose all clothing round the neck and chest; fourthly, convey the patient, still in the recumbent position, to the nearest hospital. Stretchers for this purpose ought to be available at known points, or at least at every police station.
Hints for Emergencies, Issue 7982, 10 August 1889, Supplement
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