Common Accidents and Emergencies

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Abdominal Injuries

Never give anything to eat or drink to the patient. Cover wound with sterile or freshly laundered material, pad of cotton wool and firm, but not tight, bandage. If wound runs across the stomach, bend patient's knees and support in this position.

Raise head and shoulders, and support them. If wound runs downwards, keep legs straight and do not raise head. These two positions help to draw the two edges of the wound together. Get medical aid at once.

Abrasions

Skin-deep wounds where the protective outer skin has been scraped away or grazed.

Clean the area well with warm soapy water or under running tap to get rid of gravel and dirt. Put plenty of acriflavine or other non-greasy antiseptic cream on clean dressing, pad with cotton wool, and bandage. Keep the injured part raised to reduce pain and bleeding.

Alcohol

Alcohol taken with barbiturates is a dangerous combination and must be avoided.

Never give alcohol to injured people unless ordered by a doctor.

Apoplexy

Rupture of a blood vessel in the brain tissue of elderly people causes collapse and unconsciousness with flushed face and noisy breathing.

Asphyxia

Suffocation. Where breathing has stopped or there are signs of failure of breathing, begin artificial respiration at once and continue until breathing starts.

The simplest method is mouth-to-mouth or mouth-to-nose breathing into the patient. Head of casualty must be fully tilted back-wards to ensure clear airway. If patient's colour does not improve after the first few breaths, look for obstruction in the throat (food, dental plates, vomit, etc.) : clear obstruction, tilt head well back and try again. Send for the doctor.

Aspirin Overdose

An overdose of 50 (300mg each) aspirin tablets constitutes a case of moderate to severe poisoning in an adult. Remove dentures if patient vomiting. Rush him to hospital for stomach washout and intravenous therapy. An infant is very vulnerable to excess aspirin : tickle the back of his throat to make him vomit up any tablets and hurry him for medical attention.

Barbiturate Overdose

Patient is dazed, semiconscious, or in a deep coma according to the quantity taken: breathing slow and snoring. Telephone for the doctor; remove dentures and mucus from mouth and nose. Estimate number of tablets taken and when, and give container to doctor so that appropriate measures can be taken when the patient reaches hospital.

In a mild case, give a conscious patient an emetic ( ½ teaspoonful mustard in a tumblerful of water). After he vomits give strong coffee. Call the doctor.

Berries

Poisonous berries, red, green, or black, are not fatal on the whole to adults but can cause alarming symptoms such as severe vomiting. Get medical aid, try to discover what type of berry has been eaten and, if there are any signs of failure of breathing, start artificial respiration. Severe vomiting or diarrhoea may cause cramp in the limbs, so give a conscious patient plenty of fluids to which sugar and salt (2 teaspoonful of each to 1 pint) has been added. Never give anything by mouth to an unconscious person.

Bites

Dog. Small punctured wounds with very little bleeding. Cover with dry dressing and get medical aid. Rabies is not likely nowadays in Great Britain : a greater danger is from tetanus carried by dog from soil.

ANT, MIDGE, BEE, WASP. When bite is on the skin, remove the sting with tweezers or point of a needle sterilised by passing tip through a flame or by dipping in spirit. Apply a weak solution of household ammonia.

A bite near the eye or in the mouth is more dangerous. Apply a solution of bicarbonate of soda (one teaspoonful to a tumblerful of water), or give as a mouth-wash. When sting is in the mouth, get medical aid. (Faintness, pallor, cold skin indicate shock.) In severe cases breathing may fail; apply artificial respiration if this should occur.

Bleeding

Bleeding dueto accidents requires immediate action. If severe (gushing or spurting out of the wound) stop flow of blood by firm pressure directly on bleeding point with fingers or thumbs (over a clean pad if at hand).

Sit, or preferably lay the patient down to lessen bleeding. Raise and support the bleeding part, unless fractured.

Wipe off dirt with clean dressing but never disturb a formed blood clot. Apply dry dressing, cotton wool pad, and bandage firmly. Get medical aid.

If glass is in a cut, do not remove it (unless free on surface) ; raise limb, cover whole wound with a loose dressing and avoid direct pressure on it. Indirect pressure can be used on nearest pressure point to stop blood flow.

Where there is no outside wound, keep patient warm, support in most comfortable position. Give nothing by mouth. Get medical aid. Do not move patient unless it is essential for his immediate safety to do so.

Blisters

From Burns and Scalds. Do not break blisters. Cover area with sterile dressing or freshly laundered material, apply generous pad of cotton wool, and bandage lightly. Raise and support a limb. Do not apply lotions, or creams, or butter, etc., in severe cases.

From Chafing or Rubbing : treat as for minor burn.

If swelling or inflammation persists, get medical advice.

Breath Odour

Acetone odour (smells like nail varnish remover) indicates a diabetic who has taken insufficient insulin or omitted an injection; as a result, he may become unconscious and the breath smells of acetone. Immediate medical aid is required. See if patient carries a card indicating that he is a diabetic. Call a doctor or get patient to hospital without delay.

Breathing Difficult

Remove any obstruction from the throat. Raise and put a support under head and shoulders, unless fracture of the skull suspected. Get medical help.

Breathing Stopped

Start artificial respiration at once. Send for doctor.

Broken Bones (Fractures)

Act promptly. Treat a swollen sprain as a fracture until the doctor examines it.

(a) Immobilise the whole part (not the small site of fracture) by securing it firmly (not tightly) with band-ages over the clothing, after padding between limbs, and with splints (broom handle or umbrella for leg) if necessary, to a sound part of the body to prevent further injury. Do not move patient unless essential to his immediate safety to do so, in which case do not attempt this until the part is securely protected against movement (immobilised).

(b) Keep patient warm and at rest. Do not give more than a sip or two of water in case an anaesthetic will be given in hospital. Get medical aid.

Fractured skull should not be handled by untrained persons.

For full details regarding first aid for fractures of various bones.

Bruises

Immerse part alternately in hot and cold water. Alternatively, apply a cold compress made of a pad of material wrung out in equal parts of spirit and cold water, or in tincture of arnica ; when the bruise is near the eyes, use cold water only. If ice is applied it must be in a bag (preferably flannel cloth) or you will 'burn' the patient.

If swelling or pain persists, get medical advice.

Bumps

Treat as for bruises. A hard fall in children may dislocate a joint. If dislocation is present do not attempt to reduce it; support the injured part and get the doctor.

Burns

In young children, especially infants, even a small burn is a serious injury. The child should be taken to hospital without delay.

Minor Burns from electric iron, hot saucepan, etc. Immediately place the hand, etc., under a gently running tap or immerse in a bowl of cool water for at least ten minutes. Cover with a dry dressing or freshly laundered handkerchief, etc. Let the patient sit or lie down quietly and give a warm drink.

Do not break blisters. Do not apply oil, ointments, or lotions.

Severe Burns. To lessen the spread of heat in the burnt tissue and ease pain, place the part gently under running water or immerse in cool water for at least ten minutes or until the pain ceases. Remove rings, belt, boots, etc., before swelling occurs.

Leave dry burned clothing on; it will be already sterilised by the heat. Lay the patient down. Cover the whole injured part with a dressing, or clean sheet, or pillowcase, etc.

Get a badly burned patient to hospital as soon as possible. He may be given sips of cold drinks frequently, if he is conscious.

Acid Burns. Act quickly - remove contaminated clothing (but be careful not to contaminate yourself). Flood affected part with water continuously for some fifteen minutes, allowing water to drain safely away. Then treat as for Severe Burns.

Alkali Burns. Brush off any particles of caustic soda or caustic oven cleaner, etc. Then treat as for Acid Burns.

Electric Burns. Switch off current before touching the patient. Start artificial respiration at once if breathing has stopped. When breathing restored then treat burns.

Choking

Food in Air Passage. Pat the patient sharply on the back where the neck meets the shoulders.

Objects, Vomit, or Blood in the throat. Pass two fingers down the throat and try to remove object. If this fails, put patient on the floor face downwards and pat sharply on the back as above. If this fails after two or three attempts, get a doctor. If breathing shows signs of failing, start artificial respiration.

Concussion

A fall or a blow on the head may cause concussion which can vary from a momentary 'blackout' to stupor or coma. The person often vomits or feels sick while recovering. Partial or complete loss of memory of what happened before the event may be experienced. No injury to the head should be treated lightly-the patient should be kept quiet and, if there has been any loss of consciousness, a doctor's advice should be sought before the patient goes about his normal business.

In cases of stupor or coma, treat as for Unconscious-ness.

Convulsions

In Infants. The body may twitch, the face will be extremely pale or bluish, the breath held, the eyes turned upwards, and a little froth may appear at the mouth. Hold the baby with his head on one side to let the saliva escape. Lay him in cot padded at ends and sides. Apply cool pack to his head and sponge limbs with tepid water. Telephone for the doctor.

Put patient where he cannot injure himself.

Coughing

If this comes on suddenly there may be something stuck in the throat: examine for this. Pat patient on the back and give sips of water. Get medical advice if coughing persists.

Cramp

Massage the affected part and apply gentle warmth to painful area. The cramped muscles should be forcibly but gently stretched. The cramp may be due to loss of fluid through diarrhoea, vomiting, or sweating, and it is most important to encourage the person to drink slowly as much as possible of salt water (2 tea-spoonful of salt to each pint). Thermotabs are useful salt tablets for cramps from excessive sweating.

Stomach cramp may be due to food poisoning.

Crush Injuries

Treat for shock. Treat failure of breathing by giving artificial respiration. Get medical aid quickly. Reassure the patient and be careful not to give anything by mouth if internal injuries are suspected.

Cuts

Deep Cuts with severe bleeding. Arrest bleeding at once. If cut is long or gaping, take patient to hospital to have it stitched.

Dirty Cuts. Brush off loose grit and dirt. Wash under running tap and with swab of cotton wool dipped in antiseptic (Savlon or Dettol according to instructions on the bottle) to clean wound. If any sign of inflammation see a doctor.

Embedded Splinters. Do not remove deeply embedded large splinter of wood, metal, or glass. Take patient to hospital. If needle is broken and embedded, mark with ink the spot where it entered, and take patient to hospital.

Slight Clean Cuts. Swab with antiseptic, wash off, and dab with spirit; use adhesive dressings (Elastoplast or Band-Aid) from your First Aid box. If wound is painful next day, or shows any signs of inflammation, go to the doctor.

Diabetic Crises

Diabetic Coma. The patient is unconscious, skin dry, breathing like deep sighs, breath smells of new-mown hay, pulse fast but weak. Send for doctor immediately, stating signs and symptoms.

Insulin Overdosage. Patient may appear excited or may be unconscious or faint, skin sweaty and pallid, breathing shallow but breath has no special odour. If the patient is able to swallow give him sweets, jam, or a sweet drink. Always test ability to swallow by pouring a teaspoonful of water between the cheek and gums. Call a doctor.

Diarrhoea

A sudden attack of diarrhoea may denote food poisoning. In children it may mean that they have eaten unripe fruit. Always try to find out the history behind an attack. See that fluids are given and if the attack does not disappear quickly, get medical advice.

Dislocations

On no account should any attempt be made to deal with a dislocation other than to make the person as comfortable as possible until hospital treatment is available. Support the joint in the most comfortable position with a sling, with pillows, etc. ; avoid jarring or unnecessary movement.

Do not give cups of tea or coffee, only sips of water, as the patient is likely to need an anaesthetic when the dislocation is put right: treatment will be delayed if he has eaten or drunk anything.

Drowning

Artificial respiration must be started at once if breathing fails. The mouth-to-mouth or mouth-to-nose method can be started while the casualty is still in the water.

Drunkenness

It is often helpful to induce vomiting; give stomach washout using warm water, in severe cases. Strong black coffee and glucose should then be given.

A smell of alcohol in the breath need not indicate drunkenness; alcohol may have been taken for collapse. If patient unconscious, treat as for Unconsciousness.

Earache

For mild earache and that associated with the common cold, keep side of face warm (woollen scarf, hot-water bottle). Take a 300-milligram aspirin tablet; half for a child of 4 to 8 years.

Ear inflamed-obtain medical aid immediately.

Ear, Discharge From

If discharge follows an injury, suspect fracture of the base of the skull. Do not move patient. Get a doctor. If discharge is from some other cause, such as after an attack of measles, see a doctor. Do not clean or dig around. The doctor will tell you what to do.

Ear, Insect In

Pour a few drops of olive oil or tepid water into the ear hole and the insect should float up and can be removed. If insect does not float or there is anything else in the channel, leave ear alone and get medical advice. Ears can be damaged by unskilled probing.

Electrical Injuries

Switch off current.

If breathing fails start artificial respiration.

In cases of minor shock, reassure the person. Keep him at rest and give warm drinks: warm water containing 1 teaspoonful of bicarbonate of soda to the pint is useful.

Emotional Upset

Can produce primary shock or hysteria. Keep the person warm. Be firm and comforting without giving excessive sympathy. Get a doctor: a sedative may be necessary.

Epileptic Fits

Minor Epilepsy. Pale face, eyes staring, brief period of unconsciousness resembling a fainting attack. Keep patient quiet. Prevent him injuring himself upon objects around.

Major Epilepsy. Patient often has a warning 'aura' (sensation of restlessness, irritability and headache). The fit goes through four stages: (1) sudden loss of consciousness, sometimes preceded by a cry; (2) face flushed and congested, patient rigid; (3) the convulsions start and it is then that the patient may injure himself by violently throwing his arms and legs about, or bite his tongue; (4) the convulsions stop. The patient will be dazed and confused and may act strangely without knowing what he is doing. The duration of the convulsions and the confused state varies.

Treatment. Do not restrain the person; only prevent him from injuring himself on surrounding objects. Place a rolled-up handkerchief, or a spoon handle wrapped in material, between his back teeth to prevent the tongue being bitten. Raise patient's head slightly, unfasten collar and any tightly-fitting clothing.

Do not leave patient until he is back to normal.

Eye Injuries

Corrosive Acids or Alkalis in the eye. Wash out with plenty of clean water; a bowlful in which the patient can blink his eye. Get medical aid.

Foreign Body embedded in the Eyeball : make no attempt to remove it: take patient to the doctor. For grit, dirt, etc., see below.

Bloodshot Eyeball after an accident may denote a fractured skull. Do not move patient but get medical aid.

Dust, Grit, or An Eyelash may cause bloodshot, eyeballs. Do not let patient rub his eye. If particle is not on the eyeball, pull down lower lid and remove particle with corner of clean handkerchief soaked in water. If particle on upper lid.

Wounded Eye. Lay patient down to rest. Close lid and cover with soft pad of cotton wool from forehead to cheek. Bandage lightly. Hasten patient to hospital.

Eyes are delicate things and if there is the slightest doubt about the condition-running eye, sticky eyes, etc. - get medical advice. Do not try home remedies and endanger your sight.

Fainting

Feeling giddy, sick; face pale; skin clammy and cold; pulse weak and slow; breathing shallow. Unless the patient has heart trouble, or there is any other reason not to do so, raise the legs higher than the head when laying the person down.

Undo tight clothing at neck, chest and waist. Remove garters. Ensure plenty of air. In a crowded vehicle, sit patient on a seat, loosen collar and waistband, and bend head down between his knees.

If the person does not recover almost immediately, get medical aid. Sal volatile may be given, but do not force the person to take it.

`If you give smelling salts, test their strength yourself and be sure to apply them with care.

Fatigue

If person faints from fatigue and exhaustion, treat as for fainting and then let him rest, preferably lying down, and keep him warm.

Fishbone in The Throat

If the fishbone is stuck in the throat do not try to remove it yourself. You can try giving a piece of dry bread to eat; this may dislodge the bone but, if one or two tries do not succeed, take the patient to a doctor. Keep calm yourself and reassure the sufferer.

Fish Hook in The Skin

If deeply embedded, do not remove it. Take patient to hospital. If superficial, cut line and ease hook through the skin, point first.

Fractures

Broken bones must be immobilised immediately by being bandaged firmly to a sound part of the body to prevent further injury. Treat for shock. Get a doctor. Avoid unnecessary moving as this increases pain. Reassure the patient and remain calm yourself.

Frostbite

After prolonged exposure to cold the ears, hands and feet, nose and face may be affected and look 'waxy' white and the sense of feeling may be lost in the affected parts; the sufferer may not realise he has frostbite. It is most important to remember that on no account must heat be applied nor should you use friction.

Do not rub with snow. Take the person into a moderately warm room and cover the affected part. Give warm sweet drinks.

If exposure has been prolonged, send for medical aid immediately.

Gas Poisoning

Turn off the gas, open windows and doors. If the gastap is not easy to locate, do notwaste time hunting for it. Take in two or three deep breaths of fresher air and hold them for as long as possible while dragging the patient out. Crouch low if coal-gas is present since it is lighter than air and rises, but this is not important with gas fumes from petrol or butane. A second person should have called the nearest doctor.

The patient's body and face has a cherry-pink colour.

Treatment. If breathing has ceased apply artificial respiration. Keep the patient warm by covering with blankets. Clean the patient's mouth, pull the tongue forward and swab the throat.

Oxygen is the best antidote so make sure that you tell the doctor (or the emergency services) that gas poisoning is the cause so that he will bring oxygen or other antidotes with him.

During recovery, the patient may be violent but he should remain in bed for 24 hours. Aspirin and similar drugs should not be taken for the headache.

Sewer fume, car exhaust fume, and smoke poisoning, require treatment as above.

Giddiness

Lay the patient down with the feet raised. Unless there is reason to suppose there is an internal injury, a drink such as tea, coffee, etc., may be given. Recur-rent attacks may denote the onset of some illness so see a doctor as soon as possible.

Gripes

This may be nothing more than 'wind' and may be alleviated with one of the popular stomach powders or indigestion tablets. If relief is not felt within three or four hours see a doctor.

Gunshot Wounds

The treatment of gunshot wounds follows the general pattern and rules which apply to any injury associated with severe internal and external bleeding. There may be both an entry and an exit wound to treat. The added dangers are (a) the bullet may be lodged in or have damaged an internal organ (lung, kidney, etc.) or may have severed an important blood vessel ; or (b) the bullet may have fractured a bone (leg, arm, ribs, etc.). The First Alder must therefore take particular care in handling the patient as these several points must be considered. Treat the wound, or wounds. Treat for shock. Get medical aid at once. Watch for a worsening of the condition such as unconsciousness, or failure of breathing. Treat broken bones.

Haemorrhage

This means bleeding and, if severe, the flow must be stopped at once. If the wound is clean, apply direct pressure to the bleeding point with a pad and bandage; if possible raise the limb.

Headache

Treat with tablets containing aspirin, preferably washed down with milk as this helps to avoid the sick feeling that some people get with these preparations. If the headache persists see a doctor. Children often start one of the infectious diseases with a severe headache.

Heart Attack

There are two common kinds of heart attack. (a) The symptoms of diseases such as coronary disease or angina pectoris are pain, sometimes very severe, in the chest or in the pit of the stomach.

The face may be pale or even ashen, and this is due to lack of oxygen in the blood. (b)The second type is where there is chronic heart disease. Symptoms are breathlessness, face a bluish colour, the sufferer may collapse suddenly with vomiting or spitting blood, and show all the other signs of shock.

In either case do not move the person unnecessarily. Send for a doctor at once. Support patient in a sitting position but make sure he cannot fall down. Undo tight clothing at neck, waist and chest, remove garters, etc. The breathing of an angina patient may fail so mouth-to-mouth resuscitation should be given immediately, with external heart compression if necessary. Hasten to hospital.

Hernia

Hernia is usually referred to as rupture and occurs most frequently in the groin, at the navel, or through the scar of an abdominal wound. Lay the patient down, raise his head and shoulders and support his knees by bending them over a pillow. Get a doctor. Do not attempt to reduce the swelling.

Hiccup

A most effective way of stopping common hiccups is to breathe deeply in and out of a paper bag 'holding it over the mouth and nose. In some cases it is relieved by taking repeated sips of ice-cold water while the breath is held as long as possible.

If the attack persists seek a doctor. In babies, try patting them on the back or give a moistened spoon dipped in sugar to lick.

Household Bleaches Swallowed

Swallowed bleaches produce a choking, burning sensation in the mouth; sometimes vomiting. Detergents cause nausea, stomach discomfort, vomiting. In both cases give milk and copious fluids. Rest in bed. Large quantities unlikely to be swallowed.

Hysteria

The temporary condition can usually be dealt with by firm kindness; too much sympathy is bad, but the patient should not be bullied. The more serious form, with body rigid and patient apparently unconscious, convulsions, and falling to the ground, is alarming for the spectator. Treat as for a mild attack but, if patient does not improve, get a doctor who may prescribe a sedative.

Itching

If accompanied by a rash, it may indicate an infectious disease, e.g. chickenpox. Examine the child and report to the doctor. Threadworms (usually in children) often cause itching around the anus particularly at night. Get medical advice to remedy the condition as it can spread quickly among other children.

A sudden skin irritation in a person allergic to certain foods or substances can be relieved by applying an antihistamine cream or ointment, or by taking anti-histamine tablets. The basic remedy is to avoid the troublesome substance.

Match Poisoning

Give a child milkto drink if match-heads swallowed.

Nausea

Feeling sick is common, particularly in children. If nausea is due to stuffy atmosphere, ventilate room and take child for a short walk in fresh air; if due to over-tiredness, give a fruit juice or glucose drink and put child to rest; if a preliminary sign of car-sickness, break the journey and let the child walk or get around in the fresh air. Glucose tablets or sweets, and sea-sickness tablets (e.g. Kwells, Sea-legs, Marzine) are often helpful to persons prone to travel-sickness.

Nausea may be due to the onset of infectious diseases: watch for further signs and symptoms such as headache, rise in temperature, listlessness, and if they do not subside within three or four hours, get medical advice.

Needle Embedded in Flesh

If the needle can be easily extracted with a pair of tweezers, do so: if the point has broken off, mark the spot with a Biro or ink and get the personto hospital as quickly as possible.

Nose Bleeding

Do not be alarmed by what seems to be a great deal of blood. Loosen all tight clothing around the neck and chest, at the waist, remove garters, etc. Seat the person in a current of air and tell him to breathe through the mouth. Pinch the nostrils firmly but do not try to plug the nose.

A cold compress applied to the forehead and at the back of the neck may help. Patient must not blow his nose. Reassure children who may be alarmed by a bleeding nose. If bleeding persists, get medical advice.

Nose, Foreign Body in

The person must breathe through the mouth. Do not attempt to remove the object but get medical aid.

Pallor

A shock caused by good or bad news, motion-sickness accompanied by nausea, and vertigo (fear of heights) can all cause excessive paleness of the face, but if pallor persists call in the doctor.

Palpitations

These may occur, particularly in stout or elderly people, after they have had a heavy meal followed by some energetic activity. Palpitations sometimes follow emotional stress and affect persons with heart conditions. In all cases, reassure the sufferers. Make them rest and, if there is any doubt as to the seriousness of the underlying condition, call in the doctor.

Phenol

Commonly called carbolic acid. Needs urgent removal from the skin owing to its corrosive and deeply penetrating action into flesh. Promptly remove contaminated clothing. Rub the skin for ten minutes with swabs soaked in water. Apply a dressing. Urgent: remove to hospital.

Plastic Bags

These must be kept out of reach of children under ten years of age: also out of reach of anyone who has been seriously depressed. If the enveloping bag is placed over the head, either in play or on purpose, a person can die of asphyxia in as little as four minutes. Give artificial respiration if breathing stops.

Rashes

Nappy Rash. Some children have excessively tender skins, and even constant nappy changing does not prevent a painful, red rash. Get your doctor to prescribe a napkin disinfectant and a good ointment. Make sure that the child is kept dry. Use zinc ointment generously. Boil nappies and dry them in the sun. Avoid use of plastic or rubber pants.

Infections. Rashes accompanied by a running nose, signs of a cold or a temperature, may be the onset of an infectious disease. Get the doctor's advice.

Rupture

Common name for abdominal hernia. Sudden swelling, usually in the groin, pain, and sometimes vomiting.

Scalds

But remove wet clothing if not adhering to scalded skin.

Shivering

Cold. In cold weather it is a natural skin reaction indicating that more covering is needed. Small children and elderly people need extra warmth in cold weather, particularly in the bedroom. Extreme changes in temperature are bad for them and should be avoided.

Fevers. Shivering associated with fevers is a common feature and may be accompanied with a rise in temperature. Guard against the patient getting a chill, keep him warm and maintain an even warm temperature in the room. Get the doctor.

Shock

Is present in all cases of accident or emotional upset. Rest, warmth and comforting reassurance are the main essentials of treatment. Warm sweet drinks, sipped, should be given unless there are abdominal injuries, broken bones, or haemorrhage. For fuller details.

Snake Bite

In Great Britain, the adder venom is not strong enough to justify incision and suction of the bitten area. Rest, and immobilisation of the limb are adequate.

In countries where snake-bite poisoning may be deadly, prompt (within two or three minutes) treatment is vital. Tie a ligature on the heart side of the bite: a strong rubber band, firmly applied, is excellent, or strips of clothing tied round the limb can be tightened by twisting with a stick. The ligature must be released for one minute in every twenty to allow arterial blood flow. As the injection of carbolic soap solution provides effective first aid, travellers in snake-infested areas might carry a hypodermic syringe and carbolic or other soap. Shake a piece of carbolic soap the size of a walnut in a cupful of warm water until dissolved, then inject 1 to 2 ml. of the solution under the skin around the bite marks of cobras or kraits. Get medical aid speedily as patient must receive antivenom serum injections; meanwhile treat for shock. Note type of snake for the doctor to provide the appropriate serum.

Mouth-to-mouth breathing if respiration fails.

Suffocation

Soft pillows for infants, or plastic bags over the head of a small child may cause suffocation. The face will be blue, showing lack of oxygen in the blood. If breathing has ceased, start artificial respiration. Every second counts in getting oxygen into the blood. When breathing recommences, get a doctor.

Sunburn

Can be serious; if blistering is severe, get medical aid. If no blistering, make a thin paste of bicarbonate of soda and water, and dab on to affected parts. Antiseptic non-greasy creams or calamine lotion may give relief, but do not apply butter or grease, and do not break any blisters.

Sunstroke

Often associated with heat stroke symptoms, i.e. vomiting, rise in temperature, cramp. Keep patient in a cool place at rest. For cramp give repeated saline drinks (2 teaspoonful salt to 1 pint of water). Apply cold compress to the head. If symptoms of raised temperature and vomiting persist, get medical attention.

Throat, Objects Lodged In

For easily removed objects, such as a piece of food in the back of the throat, pat patient sharply on the back or remove object with two fingers. If you do not immediately succeed, get a doctor. If breathing fails use artificial respiration.

Toothache

The only lasting cure is to see a dentist and have the tooth repaired or extracted ; everyone should have regular check-ups. Oil of cloves rubbed on the gum, or aspirin dissolved slowly against the painful tooth sometimes gives temporary relief.

Unconsciousness

The most important thing to discover is whether the person is breathing or not. If breathing has failed, start artificial respiration. If breathing is satisfactory loosen tight clothing and, unless internal injuries or fractures make it impossible, place patient in the recovery position with head backward as on. Stop any severe bleeding. Record for the doctor the pulse rate, depth of breathing, level of unconsciousness (coma, stupor, drowsiness), and reaction and size of pupils to light. Cover patient with blanket and one beneath. Get medical aid. Give no drinks to an unconscious person but moisten his lips with water if he rouses.

It is essential that anyone who has been unconscious, even momentarily, consult his doctor soon.

Varicose Veins

If varicose veins rupture and bleed, apply direct pressure over a folded handkerchief on the bleeding point. Lay casualty on his back and raise the leg high. Apply a dressing, pad and bandage firmly in position. Send for a doctor.

Vomiting

Find out the cause. If a poison has been swallowed, e.g. medicines or tablets left carelessly around, tainted foods, or wayside berries, keep a specimen of the vomit and any pill boxes, etc. for the doctor's information. Send for a doctor.

If overeating has caused vomiting

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