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of vegetable astringents-as oak-bark, tannic acid, catechu, etc. Make cold applications over the abdomen. It may be well to give a small dose of opium to diminish the peristaltic action. This may occur in the course of typhoid or yellow fever, but is more common from hæmorrhoids than any other cause.

With hæmaturia, keep the patient lying down, and give hot or ice-cold injections into the rectum or vagina. Blood in the urine may come either from the kidneys, bladder, or urethra. Note whether it appears at the beginning or end of micturition, and whether its passage is accompanied by pain.

In case of uterine bæmorrhage, especially when following operations, a vaginal douche of hot water, or a hot solution of alum, is especially indicated. The fluid extract of ergot, or gallic acid, may be given internally. It may be necessary to plug the vagina. One way of doing this is to introduce, as far as the mouth of the uterus, the center of a soft handkerchief, leaving the ends projecting. Pack this with small pieces of compressed sponge, or absorbing cotton, and tie the projecting ends together. The sponge is the better thing to use, for, as it becomes saturated, it will swell, making considerable pressure. After a sufficient time the plugs can be removed, one at a time, and, finally, the handkerchief. Another way is by means of a kite-tail tampon-a series of bunches of absorbing cotton, tied at intervals of a couple of inches along one string. These are introduced, one at a time, till the vagina is distended, and the end of string left hanging. Upon pulling this, the plugs easily come out in succession. Hæmorrhage following childbirth is called post-partum. Special directions for its treatment are given in the chapter upon obstetrics.

nose.

There is one other local hæmorrhage which demands some special attention: epistaxis, bleeding from the This may be either the result of an accident or a spontaneous outbreak. In the latter case it may be regarded as an effort of nature to relieve the head, and need seldom be regarded with any uneasiness. To check it, make pressure on the facial artery at the root of the nose, and make cold applications to the forehead and back of the neck. The ordinary position taken-leaning over a basin-is the worst possible. Make the patient stand erect, throw his head back, and elevate his arms, while you hold a cold, damp sponge to the nostrils. If the bleeding still persists beyond a reasonable time, gallic acid may be snuffed up, or the nostrils syringed with salt and water, ice cold (3 j-Oj). There are very few cases that these measures will not control. Avoid blowing the nose, and so disturbing the forming clots. If all other means fail, the surgeon may find it necessary to plug the nares. To do this, he will need a small flexible catheter, a strong cord, and some lint. The cord is passed through the eye of the catheter, and carried by it through the nostril to the pharynx, where the end of the string can be caught and brought out through the mouth. By means of this a plug of lint is drawn into the posterior naris; another is pushed into the anterior, and the two tied together so as to hold each other in place. They should be left in for twentyfour hours. The process is a very painful one, and only resorted to when all other means prove ineffectual.

CHAPTER XIX.

Emergencies-General conduct in accidents-Shock-Syncope-Fractures-Dislocations-Sprains-Wounds-Bites and stings-What to do in case of fire-Burns-Foreign bodies in the eye-ear— nose—throat — Asphyxia — Artificial respiration — Sunstroke— Lightning-Freezing-Convulsions-Apoplexy-Other causes of

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insensibility-Poisons.

SOME exceptional cases will arise, in which whatever is to be done must be done at once, without waiting for the arrival of skilled service, and in these emergencies, if a nurse is present, she will naturally be looked to in the place of a doctor. Just how much the nurse is justified in doing, it is difficult to say; it depends upon the case, and upon the nurse. You will not wish to assume responsibilities that do not belong to you, but, when a doctor can not be at once obtained, prompt action on your part may save life. Do not try intricate experiments; remember that the simplest things are often the most useful, and that it is usually safer to do too little than too much. As a rule, if you do not feel sure what ought to be done, do nothing. But, if you have made any use of your opportunities, you will know, at least, more than the utterly uninstructed crowd. Now is a chance to practice the coolness and presence of mind which your training has led you to cultivate. Above all things do not get excited, or you will forget all that you would otherwise know.

In case of any accident, send a message to the doctor, describing as well as you can the nature and urgency of the case, so that he may come prepared with the necessary appliances; try to get rid of everybody who can not be made useful, so as to secure plenty of fresh air and room to work. If respiration is suspended, or the danger imminent, treatment must be begun at once, on the spot, without loss of time, otherwise the patient may be carried to the nearest convenient house. For this purpose, a stretcher, or something which will take its place, on which he can lie horizontally, should be provided. The bearers should be instructed to carry it in the hands, not on the shoulders, and to avoid unnecessary jolting. It is better for them not to keep step.

Have a warm bed ready to put him in. Remove the clothes with as little disturbance as may be, and do not cut anything that can be ripped. If a foot is hurt, the shoe and stocking will generally have to be sacrificed, but almost everything else can be ripped without ruining. Take the clothes from the sound side first, but, in putting on a garment, begin with the injured side. Special directions for undressing a woman are hardly needed; in case of a man, a point to be remembered is to unfasten the suspenders behind as well as in front. All the clothing can then be easily removed under cover of a sheet.

Severe injury of any kind may be followed by shock, or collapse-a complete prostration of the vital powers. The patient lies in an apathetic state, though not unconscious, the surface pale and covered with cold perspiration. There will be an abnormally low temperature, feeble pulse, dilated nostrils, drooping lids, both mental and muscular weakness, and, in less severe cases,

nausea and vomiting. Death may be caused indirectly by failure to rally from this condition. Keep the patient's head low, and give stimulants till the heart's action is revived; apply heat to the extremities and the pit of the stomach. Hot tea, coffee, or beef-tea, may be given if it can be retained. When there is nausea, brandy is the best form of stimulant.

Syncope, or fainting, manifests many of the same signs as shock, and mild forms of the latter are often confounded with it. There is unconsciousness, occasioned by an insufficient supply of blood to the brain. Do not raise the head, keep it as low as, or lower than, the feet; this position alone, with plenty of fresh air, will often restore consciousness. If the condition persists, proceed as in case of shock. Ammonia may be given by inhalation, but not too strong, as the irritation may occasion dangerous bronchitis.

Broken bones are among the most common casualties. It is a mistaken impression that a fracture must be set immediately. It will do less harm for it to be left a day or two without splints, than for them to be awkwardly applied. Handle the injured part as little as possible, and do not attempt to do more than to keep the patient comfortable and quiet until a competent surgeon can be obtained. Merely temporary splints may be put on, made of pasteboard, shingles, or any smooth and stiff material at hand, to prevent the spasmodic twitching of the muscles, which adds to the pain. If it is a limb that is broken, get it in a natural position, making some extension, and support it firmly. Elevate the limb slightly, and apply cold water over the seat of fracture to keep it from swelling. A broken leg may be laid in a pillow, which is then bandaged closely around it, or bound to a straight stick, padded,

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