The Home Medical Library Volume I Part 10

=Treatment.=--The treatment for dislocation consists in bending the forearm backward to a straight line, or even a little more, and then while an a.s.sistant holds firmly the arm above the elbow, the forearm should be grasped below the elbow and pulled with great force away from the a.s.sistant and, while exerting this traction, the elbow is suddenly bent forward to a right angle, when the bones should slip into place.

The after treatment is much the same as for most fractures of the elbow. The arm is retained in a well-padded right-angled tin splint which is applied with three strips of surgeon's plaster and bandage to the front of the arm and forearm (see Fig. 33) for two or three weeks.

The splint should be removed every few days, and the elbow joint should be moved to and fro gently to prevent stiffness, and the splint then reapplied.

=DISLOCATION OF THE HIP.=--This occurs more commonly in males from fifteen to forty-five years of age, and is due to external violence.

In the more ordinary form of hip dislocation the patient stands on the sound leg with the body bent forward, the injured leg being greatly shortened, with the toes turned inward so much that the foot of the injured limb crosses over the instep of the sound foot. The injured limb cannot be moved outward and but slightly inward, yet may be bent forward. Walking is impossible. Pain and deformity of the hip joint are evident.

The only condition with which this would be likely to be confused is a fracture of bone in the region of the hip. Fracture of the hip is common in old people, but not in youth or middle adult life. In fracture there is usually not enough shortening to be perceived with the eye; the toes are more often turned out, and the patient can often bear some weight on the limb and even walk.

=Treatment.=--The simplest treatment is that recommended by Stimson, as follows: the patient is to be slung up in the air in a vertical position by means of a sheet or belt of some sort placed around the body under the armpits, so that the feet dangle a foot or so from the floor, and then a weight of about ten or fifteen pounds, according to the strength of the patient's muscles, is attached to the foot of the injured leg (bricks, flatirons, or stones may be used), and this weight will usually draw the bone down into its socket within ten or fifteen minutes.

[Ill.u.s.tration: FIG. 34.

REDUCING DISLOCATION OF HIP (REFERENCE HANDBOOK).

Patient lying on table; uninjured leg held by a.s.sistant; leg of dislocated side at right angles; note weight at bend of knee.]

Or the patient may a.s.sume the position shown in the accompanying cut, lying p.r.o.ne upon a table with the uninjured leg held horizontally by one person, while another, with the injured thigh held vertically and leg at right angles, grasps the patient's ankle and moves it gently from side to side after placing a five-to ten-pound sand bag, or similar weight of other substance, at the flexure of the knee. When the dislocation has been overcome the patient should stay in bed for a week or two and then go about gradually on crutches for two weeks longer.

=SURGICAL DRESSINGS.=--Sterilized gauze is the chief surgical dressing of the present day. This material is simply cheese cloth, from which grease and dirt have been removed by boiling in some alkaline preparation, usually washing soda, and rinsing in pure water. The gauze is sterilized by subjecting it to moist or dry heat. Sterilized gauze may be bought at shops dealing in surgeons' supplies and instruments, and at most drug stores. Gauze or cheese cloth may be sterilized (to destroy germs) by baking in a slow oven, in tin boxes, or wrapped in cotton cloth, until it begins to turn brown. It is well to have a small piece of the gauze in a separate package, which may be inspected from time to time in order to see how the baking is progressing, as the material to be employed for surgical purposes should not be opened until just before it is to be used, any remainder being immediately covered again. Cut the gauze into pieces as large as the hand, before it is sterilized, to avoid cutting and handling afterwards. Gauze may also be sterilized by steaming in an Arnold sterilizer, such as is used for milk, or by boiling, if it is to be applied wet. Carbolized, borated, and corrosive-sublimate gauze have little special value.

[Ill.u.s.tration: PLATE I.

Fig. I.

Fig. II.

Fig. III.

Fig. IV.

APPLYING A ROLLER BANDAGE (REFERENCE HANDBOOK).

Fig. I shows method of starting a spiral bandage; Fig. II, ready to reverse; Fig. III, the reverse completed; Fig. IV shows spica bandage applied to groin.]

Absorbent cotton is also employed as a surgical dressing, and should also be sterilized if it is to be used on raw surfaces. It is not so useful for dressing wounds as gauze, since it mats down closely, does not absorb secretions and discharges so well, and sticks to the parts.

When torn into b.a.l.l.s as large as an egg and boiled for fifteen minutes in water, it is useful as sponges for cleaning wounds. Sheet wadding, or cotton, is serviceable in covering splints before they are applied to the skin. Wet antiseptic surgical dressings are valuable in treating wounds which are inflamed and not healing well. They are made by soaking gauze in solutions of carbolic acid (half a teaspoonful of the acid to one pint of hot water), and, after application, covering the gauze with oil silk, rubber dam, or paraffin paper. Heavy brown wrapping paper, well oiled or greased, will answer the purpose when better material is not at hand.

=BANDAGES.=--Bandaging is an art that can only be acquired in any degree of perfection by practical instruction and experience. Some useful hints, however, may be given to the inexperienced. Cotton cloth, bleached or unbleached, is commonly employed for bandages; also gauze, which does not make so effective a dressing, but is much easier of application, is softer and more comfortable, and is best adapted to the use of the novice. A bandage cannot be put on properly unless it is first rolled. A bandage for the limbs should be about two and a half inches wide and eight yards long; for the fingers, three-quarters of an inch wide and three yards long. The bandage may be rolled on itself till it is as large as the finger, and then rolled down the front of the thigh, with the palm of the right hand, while the loose end is held taut in the left hand.

[Ill.u.s.tration: PLATE II.

Fig. I.

Fig. II.

Fig. III.

Fig. IV.

DIFFERENT FORMS OF BANDAGES.

(AMERICAN TEXT-BOOK AND REFERENCE HANDBOOK.)

Fig. I shows application of figure-of-eight bandage; Fig. II, a spica bandage of thumb; Fig. III, a spica bandage of foot; Fig. IV, a T-bandage.]

Two forms of bandages are adapted to the limbs, the figure-of-eight, and the spiral reversed bandage. In applying a bandage always begin at the lower extremity of the limb and approach the body. Make a few circular turns about the limb (see Fig. I, p. 132), then as the limb enlarges, draw the bandage up spirally, reversing it each time it encircles the limb, as shown in Fig. I, p. 134. In reversing, hold the bandage with the left thumb so that it will not slip, and then allowing the free end to fall slack, turn down as in Fig. II, p. 132.

The T-bandage is used to bandage the crotch between the thighs, or around the forehead and over the top of the skull. (See Fig. IV, p.

134.) In the former case, the ends 1-1 are put about the body as a belt, and the end 2 is brought from behind, in the narrow part of the back, down forward between the thighs, over the crotch, and up to the belt in the lower part of the belly. The figure-of-eight bandage is used on various parts, and is ill.u.s.trated in the bandage called spica of the groin, Fig. IV, p. 132. Beginning with a few circular turns about the body in the direction of 1, the bandage is brought down in front of the body and groin, as in 2, and then about the back of the thigh up around the front of the thigh, as in 3, across the back and once around the body and down again as in 2. Other bandages appropriate to various parts of the body are also ill.u.s.trated that by their help the proper method of their application may be understood.

See pages 132, 134, 136, 137. The triangular bandage (see p. 88) made from a large handkerchief or piece of muslin a yard square, cut or folded diagonally from corner to corner, will be found invaluable in emergency cases. It is easily and quickly adjusted to almost any part of the body, and may be used for dressing wounds, or as a bandage for fractures, etc.

[Ill.u.s.tration: PLATE III.

Fig. I.

Fig. II.

BANDAGES FOR EXTREMITIES (AMERICAN TEXT-BOOK).

Fig. I shows a spiral reversed bandage of arm and hand, requiring roller 2-1/2 inches wide and 7 yards long; Fig. II shows a spiral reversed bandage of leg and foot, requiring roller 2-1/2 inches wide and 14 yards long.]

[Ill.u.s.tration: PLATE IV.

Fig. I.

Fig. II.

Fig. III.

Fig. IV.

BANDAGES FOR HEAD AND HAND.

(AMERICAN TEXT-BOOK.)

Fig. I shows a gauntlet bandage; Fig. II, a circular bandage for the jaw; Fig. III, a circular bandage for the head; Fig. IV, a figure-of-eight bandage for both eyes.]

CHAPTER VI

=Ordinary Poisons=

_Unknown Poisons--Antidotes for Poisoning by Acids and Alkalies--The Stomach Pump--Emetics--Symptoms and Treatment of Metal Poisoning-- Narcotics._