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First-aid treatment of wounds of the abdomen with escape of the bowels. Send for a doctor at once. The bowels should be covered with several thicknesses of sterile gauze wet in boiled and cooled warm salt solution (a teaspoonful of salt to the quart of water). If no sterile gauze is at hand, boil a towel in a salt solution of the above strength, cool it until it is at body temperature, and then lay it over the intestines. Treat shock, which is certain to develop. After treatment.-When no doctor follows: Lay the patient on his back. part of the abdomen, raise the hips. getting bacteria on the bowels or into the wound. Sterilize the hands (p. 184). Sterilize some salt soution and cool it to body temperature. Wash the bowel with this. Examine the bowel carefully to see if it has been opened and the contents escaping. If it is apparently sound, endeavor to gently return it into the abdomen, using the hand covered with sterile gauze for this purpose. Push the part which came out last back first. Gradually in this way work the bowel back into the belly.

If the bowel has been opened, leave it on the outside, but dress with sterile gauze wet with salt solution.

POISONED WOUNDS.

Description. These are wounds into which poison has been injected at the time the injury was received. Snake bites and bee stings are examples of poisoned wounds.

SNAKE BITES.

(After Da Costa.)

Description. The bites of copperheads, water moccasins, coral snakes, and rattlesnakes are all poisonous. The diamond black rattlesnake is the most dangerous serpent of the United States. The bite from a small snake is not as poisonous as one inflicted by a large snake of the same species. The greater number of snake bites are received on the extremities. The poison fangs of snakes consist of hollow teeth which connect with the poison sac in the upper jaw. When the reptile strikes the teeth are inserted into the flesh, the poison sac is contracted, and the venom forced into the wound. There are two poison fangs, one on each side of the upper jaw. In snakes of the viper species the poison teeth lie along the back of the mouth and are dropped into a vertical position when the animal is ready to attack. Snake venom is a thin greenish-yellow fluid of characteristic odor and extremely poisonous. The mortality from bites of poisonous snakes varies, ranging from 5 per cent in the case of copperheads to about 20 per cent for the large rattlesnakes.

Symptoms. Intense pain, discolored swelling of the bitten part, which soon becomes very marked, and profound disturbance of the system. The general symptoms develop soon after the bite. They consist of great weakness and prostration, nausea, and a profuse flow of saliva. Paralysis of the muscles occur in from three to four hours. Unconsciousness is rare, but the patient falls into a kind of stupor.

Treatment. The bite is usually on the lower part of the limb, and a band made of a handkerchief, necktie, or similar article should be instantly applied a few inches about the wound between it and the heart and tightly twisted with a stick (fig. 154) to shut off the circulation to the part and prevent the poison from being carried into the system by the circulating blood. The bites of most venomous serpents consists of but two punctures. These small wounds should be freely incised with a knife and then sucked. There is no danger in sucking the wound if there are no cracks or sores in the mouth or on the tongue. After the wound has been sucked it should be cauterized. This is done by applying carbolic acid or nitric acid on the end of a stick, such as a match stick or toothpick. Most of these injuries happen in the wilds, where such chemicals can not be obtained. Cauterization may then be performed by heating a nail, a knife blade, or some other metallic object, such as a suspender buckle, in a fire and freely burning all parts of the wound. On hunting trips a cartridge may be torn open and a little gunpowder poured on the wound and then ignited with a match. Permanganate of potash has been highly recommended, and is used by injecting a 1 per cent solution into the wound and also into the surrounding tissues by means of a hypodermic syringe. The crystals of permanganate of potash may be rubbed into the wound.

After the wound has been sucked and cauterized so as to extract and destroy as much of the poison as possible, the tourniquet may be loosened. It should be allowed to remain loose for one minute and then tightened up again. Wait 20 minutes and if no alarming symptoms develop it is again released, and this time allowed to remain loose for two minutes, after which it is tightened. Another period of 20 minutes is allowed to elapse, and on this occasion the tourniquet is left off for three minutes. This procedure is continued for several hours, gradually increasing the time the tourniquet is off, and is known as using the intermittent tourniquet, the object being to allow only small quantities of the poison to get into the system at one time. If in spite of the local measures and the use of the tourniquet general symptoms develop, the patient must be given stimulants. It is commonly believed that large doses of whisky or alcohol in some form should be administered. This is a mistake, as large doses will

do harm by adding another depressant to that which is already in

the system.

Instead of whisky it is better to give aromatic spirits of ammonia, one-half teaspoonful in water every hour, and a half a cupful of very strong coffee every two hours.

External heat is sometimes useful. A compress wet with boricacid solution should be applied to the wound after the cauterization. Of recent years serums have been produced which are very effective in certain kinds of snake bites, but they are rarely obtainable when most needed.

INSECT STINGS.

BEE STING.

The stings of bees and wasps and yellow jackets are very painful but not dangerous to life unless the victim is attacked by a large number of the insects.

Treatment. If the sting remains in the flesh it should be pulled out and a drop or two of diluted ammonia water applied to the wound. A compress wet in cold water or cold boric-acid solution will help to allay pain.

STINGS OF CENTIPEDES, TARANTULAS, AND SCORPIONS.

The stings of these insects are very much more severe than those of wasps or bees and may cause considerable general weakness, headache, sweating, and vomiting, but they are practically never fatal.

Treatment. The wound should be encouraged to bleed as much as possible and afterwards cauterized with carbolic acid or some other caustic if available. Tincture of iodine may be applied. An ice compress should be placed over the wound to limit local reaction. General symptoms, such as prostration and headache, should be treated by moderate stimulation, giving aromatic spirits of ammonia, 30 drops in water every hour and supplementing this with half a cupful of very strong black coffee if necessary. Some authorities recommend the application of a constricting band, which is gradually loosened in order to prevent the poison from being taken up by the system rapidly.

DOG BITES.

Dog bites are usually minor lacerated wounds, but are especially dreaded on account of the danger of hydrophobia, which is almost invariably fatal.

Treatment of dog bites.—If a person is bitten by a healthy dog, the wound should be thoroughly swabbed with iodine, working the medicine well into all parts of the wounded flesh with a small swab of cotton on a clean toothpick and the wound treated in other re

spects as an ordinary lacerated wound. If the dog is sick, he should be confined and carefully watched. If he remains well for 14 days, there is little danger of hydrophobia developing in the patient. In no case should the dog be killed unless it is certain he is rabid, as in this way it will be impossible to tell whether or not he had rabies unless the head is sent to a laboratory for examination. If the dog has hydrophobia or is suspected of having hydrophobia at the time the injury is recived, the wound should be thoroughly cauterized with pure nitric acid on a glass rod or the end of a match stick in the same manner as directed for the tincture of iodine. The acid should be worked thoroughly into all parts of the wound, and the point of a glass medicine dropper makes an excellent instrument for this purpose. Care should be taken not to get the acid on the sound skin. Carbolic acid, followed by alcohol, may be used for the same purpose, but is not as efficient. This cauterization should, of course, be done by a physician if one is available. After the cauterization the patient should receive the Pasteur treatment, which consists of a series of injections covering a period of some weeks.

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SYMPTOMS OF HYDROPHOBIA OR RABIES IN A DOG.

It is advisable that the public should know something about the symptoms of hydrophobia in animals. A dog which is developing the disease may show hardly any symptoms except weakness. Usually, however, the animal shows a marked change in disposition, refuses his food, is apprehensive and very restless. He is liable to run away from home, snap at anything in his way, and swallows sticks, stones, and other strange objects. Later on paraylsis develops in the lower jaw. The jaw hangs down and saliva drools from the mouth. In the last stages the hind legs become paralyzed and the dog drags them. One should be especially careful about attempting to relieve a dog who apparently has some foreign object in the throat, the symptoms being that the jaw hangs down and saliva runs from the mouth. Such animals are very apt to be rabid, and if the hand is inserted into the mouth in an attempt to remove the supposed foreign body, the person may be bitten or injured accidentally by the teeth and infected with the disease. Hydrophobia usually does not develop within less than 10 days after the person is bitten, three weeks being about the average period. In rare instances the disease has appeared many months after the receipt of the injury. If the dog is suspected of being mad and has been killed after biting some one, the head should be cut off, packed in ice, and sent by express to the nearest laboratory for examination. Usually such laboratories are maintained by State health departments at the State capital.

Other animals besides dogs contract the disease, especially wolves, and occasionally cattle develop it.

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BITES OF CATS AND OTHER SMALL ANIMALS.

These injuries are usually punctured and slightly lacerated wounds. The proper treatment is the application of tincture of iodine thoroughly worked into the wound, followed by a sterile dressing.

MOSQUITO AND FLEA BITES.

Treatment. The itching and irritation from these bites can be relieved by a lotion of carbolic acid and boric acid. It should be applied by dabbing on with a small wad of cotton, or better still by spraying it on the surface with an atomizer. To make the lotion, add a level tablespoonful of boric acid powder and 20 drops of pure carbolic acid to a half a pint of hot water. Stir well or shake until the boric acid is dissolved. Cool before using.

HEMORRHAGE OR BLEEDING.

THE CIRCULATORY SYSTEM.

The blood is a fluid which circulates through the body in closed tubes called blood vessels. There are three kinds of blood vessels, the arteries, veins, and capillaries. The blood flows from the heart in the arteries and returns to the heart in the veins. The capillaries are very minute channels which connect the arteries and veins (fig. 160). It is necessary for the blood to be in constant motion in order that food and oxygen may be carried to all parts of the body and waste substances removed.

The heart is situated behind the breast bone, almost in the middle of the chest but slightly to the left side. The function of the heart is to force the blood through the arteries and keep it moving.

The heart beats at the rate of 72 times per minute in a normal person. Excitement, fever, exercise, shock, hemorrhage, and many other conditions cause the heart to beat faster.

As long as the blood is circulated through its proper living channels it remains fluid, but when it escapes from the blood vessels in a short time it hardens and clots. The clotting of the blood forms a firm plug which serves to close the blood vessel and checks bleeding. Exposure to the air and the admixture of foreign substances hastens the formation of the clot. The clotting of the blood when it gets outside of the circulatory system, is a wise provision of nature as otherwise a slight wound would frequently cause death. There are certain individuals whose blood has very slight clotting power. It is very difficult to check bleeding from such persons and they are known as "bleeders."

The blood in the arteries is under considerable pressure due to the action of the heart. The pressure of the blood in the veins is very

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