The Home Medical Library Volume I Part 3

_Rule 2.--Tie tight bandage about limb at this point, with rubber tubing or suspenders._

_Rule 3.--Keep limb and patient warm with hot-water bottles till surgeon arrives._

In the cases of bleeding from a vein, the flow of blood is continuous, and is of a dark, red hue, and does not spurt in jets, as from an artery. This kind of bleeding is not usually difficult to stop, and it is not necessary that the vein itself be tied--unless very large--provided that the wound be snugly bandaged after it is dressed.

After the first half hour, release the limb and see if the bleeding has stopped. If so, and the circulation is being interfered with, owing to the tightness of the bandage, reapply the bandage more loosely.

In the case of an injured artery of any considerable size, the amount of pressure required to stop the bleeding will arrest all circulation of blood in the limb, so that great damage, as well as pain, will ensue if it be continued more than an hour or two, and during this time the limb should be kept warm by thick covering and hot-water bags, if they can be obtained.

Bleeding _from a deep puncture_ may be stopped by plugging the cavity with strips of muslin which have been boiled, or with absorbent cotton, similarly treated, keeping the plug in place by snug bandaging.

=BLEEDING FROM PUNCTURED WOUND.=

_First Aid Rule 1.--Extract pin, tack, nail, splinter, thorn, or bullet, IF YOU CAN SEE BULLET; do not probe._

_Rule 2.--Pour warm water on wound and squeeze tissue to encourage bleeding. Send for small hard-rubber syringe._

_Rule 3.--If deep, plug it with absorbent cotton, and put tight bandage over plug. If shallow, cover with absorbent cotton wet with boric-acid solution (one dram to one-half pint of water), or carbolic-acid solution (one teaspoonful to the pint of hot water)._

_Rule 4.--When syringe comes, remove dressing, and clean wound by forcibly syringing carbolic solution directly into wound. Replace dressing._

A small punctured wound should be squeezed in warm water to encourage bleeding and, if pain and swelling ensue, absorbent cotton soaked in a boric-acid solution (containing as much boric acid as the water will dissolve) or in carbolic-acid solution (one teaspoonful of pure acid to the pint of warm water) should be applied over the wound and covered with oil silk or rubber or enamel cloth for a few days, or until the soreness has subsided. The dressing should be wet with the solution as often as it becomes dry. Punctures by nails, especially if deep, should be washed out with a syringe, using one of the solutions just mentioned. A medicine dropper, minus the rubber part, attached to a fountain syringe, makes a good nozzle for this purpose. A moist dressing, like the one described, should then be applied, and the limb kept in perfect rest for a few days.

When a surgeon's services are available, however, self-treatment is attended with too much danger, as a thorough opening up of such wounds with proper cleansing and drainage will afford a better prospect of early recovery, and avert the risk of serious inflammation and lockjaw, which sometimes follow punctured wounds of the hands and feet. Foreign bodies, as splinters, may be removed with tweezers or a needle, being careful not to break the splinter in the attempt. If a part remains in the flesh, or if the foreign body is a needle that cannot be found or removed at once, the continuous application of a hot flaxseed or other poultice will lead to the formation of "matter,"

with which the splinter or needle will often escape after a few days.

Splinters finding their way under the nail may be removed by sc.r.a.ping the nail very thin over the splinter and splitting it with a sharp knife down to the point where the end of the splinter can be grasped.

=BLEEDING IN FORM OF OOZING.=

_First Aid Rule 1.--Apply water as hot as hand can bear._

_Rule 2.--Elevate the part, and drench with carbolic solution (one teaspoonful of carbolic acid to one pint of hot water)._

_Rule 3.--Bandage snugly while wet._

_Rule 4.--Keep patient warm with hot-water bottles._

=GENERAL OOZING= happens in the case of small wounds or from abraded surfaces, and is caused by the breaking of numerous minute vessels which are not large enough to require the treatment recommended for large arteries or veins. It is rarely dangerous, and usually stops spontaneously. When the loss of blood has been considerable, so that the patient is pale, faint, and generally relaxed, with cold skin, and perhaps nausea and vomiting, he should be stripped of all clothing and immediately wrapped in a blanket wrung out of hot water, and then covered with dry blankets. Heat should also be applied to the feet by means of hot-water bags or bottles, with great care not to burn a semiconscious patient's skin. The head should be kept low, and two tablespoonfuls of brandy, whisky, or other alcoholic liquor should be given in a half cup of hot water by the mouth, if the patient can swallow. If much blood has been lost a quart of water, as hot as the hand can readily bear, and containing a teaspoonful of common salt, should be injected by means of a fountain syringe into the r.e.c.t.u.m.

Somewhat the condition just described as due to loss of blood may be caused simply by shock to the nervous system following any severe accident, and not attended by bleeding. The treatment of shock is, however, practically the same as that for hemorrhage, and improvement in either case is shown by return of color to the face and strength in the pulse. Bleeding is apt to be much less in badly torn than in incised wounds, even if large vessels are severed, as when the legs are cut off in railroad accidents, for the lacerated ends of the vessels become entangled with blood and favor clotting.

=LOCKJAW.=--In the lesser injuries, where bleeding is not an important feature, and in all wounds as well, after bleeding has been stopped, the main object in treatment consists in cleansing wounds of the germs which cause "matter" or pus, general blood poisoning, and lockjaw. The germs of the latter live in the earth, and even the smallest wounds which heal perfectly may later give rise to lockjaw if dirt has not been entirely removed from the wound at the time of accident. Injuries to the hands caused by pistols, firecrackers, and kindred explosives, seem especially p.r.o.ne to produce lockjaw, and fatalities from this disorder are deplorably numerous after Fourth-of-July celebrations in the United States.

The wounds producing lockjaw usually occur in children who explode blank cartridges in the palm of the hand. In this way the germs of the disease are forced in with parts of the dirty skin and more or less of the wad from the sh.e.l.l. Since lockjaw is so frequent after these accidents, and so fatal, it is impossible to exert too much care in treatment. The wound should at once be thoroughly opened with a knife to the very bottom, under ether, by a surgeon, and not only every particle of foreign matter removed, but all the surrounding tissue should be cut out or cauterized. In addition, it is wise to use an injection under the skin of teta.n.u.s-ant.i.toxin, to prevent the disease.

Proper restriction of the sale of explosives alone will put a stop to this barbarous mode of exhibiting patriotism.

=Treatment.=--It is not essential to use chemical agents or antiseptics to rid wounds of germs and so secure uninterrupted healing. The person who is to dress the wound should prepare to do so at the earliest possible moment after giving first aid. He should proceed promptly to boil some pieces of absorbent cotton, as large as an egg, together with a nail brush in water. Some strips of clean cotton cloth may be used in the absence of absorbent cotton. The boiling should be conducted for five minutes, when the basin or other utensil in which the brush and cotton are boiled should be taken off the fire and set aside to cool. Then the attendant should scrub his own hands for five minutes in hot water with soap and brush.

He next takes the brush, which has been boiled, out of the water and cleans the patient's skin for a considerable distance about the wound.

When this is done, and the water and cotton which have been boiled are sufficiently cool, the wound should be bathed with the cotton and boiled water until all foreign matter has been removed from the wound; not only dirt which can be seen, but germs which cannot be seen. Some of the boiled cotton cloth or absorbent cotton, wet as it is, should be placed over the wound and the whole covered by a bandage. Large gaping wounds are of course more properly closed by st.i.tches, but very deep wounds should be left partly open, so that the discharge may drain away freely. Small, deep, punctured wounds are not to be closed at all, but should be sedulously kept open by pushing in strips of boiled cotton cloth, in order to secure drainage.

If the attendant has the requisite confidence, there is no reason why he should not attempt st.i.tching a wound, providing the patient is willing, and a surgeon cannot be obtained within twenty-four hours. In this case a rather stout, common sewing needle or needles are threaded with black or white thread, preferably of silk, and, together with a pair of scissors and a clean towel, are boiled in the same utensil with the cotton and the nail brush. After the operator has scrubbed his hands and cleansed the wound, he places the boiled towel about the wound so that the thread will fall on it during his manipulations and not on the skin. The needle should be thrust into and through the skin, but no lower than this, and should enter and leave the skin about a quarter of an inch from either edge of the wound. The st.i.tches are placed about one-half inch apart, and are drawn together and tied tightly enough to join the two edges of the wound. The ends of the thread should be cut about one-half inch from the knot, being careful while using the needle and scissors not to lay them down on anything except the boiled towel. The wound is then covered with cotton, which has been boiled as described above, bandaged and left undisturbed for a week, if causing no pain. At the end of this time the st.i.tches are taken out after the attendant has washed his hands carefully, and boiled his scissors as before.

Court plaster or plaster of any kind is a bad covering or dressing for wounds, as it may be itself contaminated with germs. It effectually keeps in any with which the wound is already infected, and prevents proper drainage.

It is impossible in a work of this kind to describe the details of the after treatment of wounds, as this can only be properly undertaken by a surgeon, owing to the varying conditions which may arise. In general it may be stated that the same cleanliness and care should be followed during the whole course of healing as has been outlined for the first attempt at treatment.

If the wound is small, and there is no discharge from it, it may be painted with collodion or covered with boric-acid ointment (sixty grains of boric acid to the ounce of vaseline) after the first day. If large, it should be covered with cotton gauze or cloth which have been boiled or specially prepared for surgical purposes. If pus ("matter") forms, the wound must be cleansed daily of discharge (more than once if it is copious) with boiled water, or best with hydrogen dioxide solution followed by a washing with a solution of carbolic acid (one teaspoonful to the pint of hot water), or with a solution of mercury bichloride, dissolving one of the larger bichloride tablets, sold for surgical uses, in a quart of water.

It is a surgical maxim never to be neglected that wounds should not be allowed to close at the top before healing is completed at the bottom.

As to close at the surface is the usual tendency in wounds that heal slowly and discharge pus, it is necessary at times to enlarge the external opening by cutting or stretching with the blades of a pair of scissors, or, and this is much more rational and comfortable for the patient, by daily packing the outlet of the wound with gauze to keep it open.

=BLEEDING FROM SCALP.=

_First Aid Rule 1.--Cut hair off about wound, and clean thoroughly with carbolic-acid solution (one teaspoonful to pint of hot water)._

_Rule 2.--Put pad of gauze or muslin directly over wet wound, and make pressure firmly with bandage._

In case of wounds of the scalp, or other hairy parts, the hair should be cut, or better shaved, over an area very much larger than the wounded surface, after which the cleansing should be done. To stop bleeding of the scalp, water is applied as hot as can be borne, and then a wad of boiled cotton should be placed in the wound and bandaged down tightly into it for a time. Closing the wound with st.i.tches will stop the bleeding much more effectively, however, and is not very painful if done immediately after the accident. The st.i.tches should be tied loosely, and not introduced nearer to each other than half an inch, to allow drainage of discharge from the wound.

=General Remarks.=--All wounds should be kept at rest after they are dressed. This is accomplished in the case of the lower limbs by keeping the patient in bed with the leg raised on a pillow.

The same kind of treatment applies in severe injuries of the hands. In less serious cases a sling may be employed, and the patient may walk about. When the injury is near a joint, as of the fingers, knee, wrist, or elbow, a splint made of thin board or tin (and covered with cotton wadding and bandaged) should be applied by means of surgeon's adhesive plaster and bandage after the wound has been dressed. In injuries of the hand the splint should be applied to the palm side, and reach from the finger tips to above the wrist. Use a splint also.

=NOSEBLEED.=

_First Aid Rule 1.--Seat patient erect and apply ice to nape of neck._

_Rule 2.--Put roll of brown paper under upper lip, and press lip firmly against it. Press facial artery against lower jaw of bleeding side, till bleeding stops. This artery crosses lower edge of jawbone one inch in front of angle of jaw._

_Rule 3.--Plug nostril with strip of thin cotton or muslin cloth._

_Rule 4.--Do not wash away clots; encourage clotting to close nostril._

=BLEEDING FROM LUNGS; BRIGHT BLOOD COUGHED UP.=

=BLEEDING FROM STOMACH; DARK BLOOD VOMITED.=

_First Aid Rule for both. Let patient lie flat and swallow small pieces of ice, and also take one-quarter teaspoonful of table salt in half a gla.s.s of cold water._

=BRUISE.=