The Home Medical Library Volume I Part 4

_First Aid Rule 1.--Bandage from tips of fingers, or from toes, making same pressure with bandage all the way up as you do over the injury._

_Rule 2.--Apply heat through the bandage, over the injury, with hot-water bottles._

=Cause, Etc.=--A bruise is a hidden wound; the skin is not broken. It is an injury caused by a blunt body so that, while the tougher skin remains intact, the parts beneath are torn and crushed to a greater or lesser extent. The smaller blood vessels are torn and blood escapes under the skin, giving the "black and blue" appearance so common in bruises of any severity. Sometimes, indeed, large collections of blood form beneath the skin, causing a considerable swelling.

Use of the bruised part is temporarily limited. Pain, faintness, and nausea follow severe bruises, and, in case of bad bruises of the belly, death may even ensue from damage to the viscera or to the nerves. Dangerous bleeding from large blood vessels sometimes takes place internally, and collections of blood may later break down into abscesses. Furthermore, the bruise may be so great that the injury to muscle and nerve may lead to permanent loss of use of the part. For these reasons a surgeon's advice should always be sought in cases of bad bruises. Pain is present in bruises, owing to the tearing and stretching of the smaller nerve fibers, and to pressure on the nerves caused by swelling. The swelling is produced by escape of blood and fluid from the torn blood vessels.

=Treatment.=--Even slight and moderate bruises should be treated by rest of the injured part. A splint insures the rest of a limb (see treatment of Fractures, p. 80). One of the best modes of treatment is the snug application of a flannel bandage which secures a certain amount of rest of the part to which it is applied, and aids in preventing further swelling. Where bandaging is not feasible, as in certain parts of the body, or before bandaging in any kind of a bruise, the use of a cold compress is advisable. One layer of thin cotton or linen cloth should be wet in ice water, and should be put on the bruised part and continually changed for newly moistened pieces as soon as the first grows warm. Alcohol and water, of each equal parts, may be used in the same manner to advantage.

When cold is unavailable or unpleasant to the patient, several layers of cotton cloth may be wrung out in very hot water and applied to the part with frequent renewal. The value attributed to witch-hazel and arnica is mainly due to the alcohol contained in their preparations.

Cataplasma Kaolini (U. S. P.) is an excellent remedy for simple bruises when spread thickly on the part and covered with a bandage. An ointment containing twenty-five per cent of ichthyol is also a useful application. Following severe bruises, the damaged parts should be kept warm by the use of hot-water bags, or by covering a limb with cotton wool and bandage, until such time as surgical advice may be obtained.

When the pain and swelling of bruises begin to subside, treatment should be pursued by rubbing with liniment of ammonia or chloroform, or vaseline if these are not obtainable. Moderate exercise of the part is desirable.

=ABRASIONS.=--When the surface skin is sc.r.a.ped off, as often happens to the shin, knee, or head, an ointment containing sixty grains of boric acid to the ounce of vaseline makes a good application, and this may be covered with a bandage. The same ointment is useful to apply to small wounds and cuts after the first bandage is removed.

=SPRAIN; NO DISPLACEMENT OF BONES.=

_First Aid Rule 1.--Immerse in water, hot as hand can bear, for half an hour._

_Rule 2.--Dry and strap with adhesive plaster, if you know how. If not, bandage snugly, beginning with tips of fingers or with toes, and make same pressure all the way up that you do over injury._

_Rule 3.--Rest. If ankle or knee is hurt, patient must go to bed._

=Conditions, Etc.=--A sprain is an injury caused by a sudden wrench or twist of a joint, producing a momentary displacement of the ends of the bones to such a degree that they are forced against the membrane and ligaments surrounding the joint, tearing one or both to a greater or less extent. The wrist and ankle are the joints more commonly sprained, and this injury is more likely to occur in persons with flabby muscles and relaxed ligaments, as in the so-called "weak-ankled." The damage to the parts holding the joint in place may be of any degree, from the tearing of a few fibers of the membrane enwrapping the joint to its complete rupture, together with that of the ligaments, so that the bones are no longer in place, the joint loses its natural shape and appearance, and we have a condition known as dislocation. In a sprain then, the twist of the joint produces only a temporary displacement of the bones forming the joint, sufficient to damage the soft structures around it, but not sufficient to cause lasting displacement of the bones or dislocation.

It will be seen that whether a sprain or dislocation results, depends upon the amount of injury sustained. Since it often happens that the bone entering into the joint is broken, it follows that whenever what appears to be a severe sprain occurs, with inability to move the joint and great swelling, it is important to secure surgical aid promptly.

Since the discovery of the X-ray many injuries of the smaller bones of the wrist and ankle joint, formerly diagnosed as sprains by the most skillful surgeons, have, by its use, been discovered to be breaks of the bones which were impossible of detection by the older methods of examination.

=Symptoms.=--The symptoms of sprain are sudden, severe pain, often accompanied by faintness and nausea, swelling, tenderness, and heat of the injured parts. The sprained joint can be only moved with pain and difficulty. The swelling is due not so much to leaking of blood from broken blood vessels as to filling up of the joint with fluid caused by the inflammation, although in a few days after a severe sprain the skin a little distance below the injury becomes "black and blue" from escape of blood caused by the injury.

=Treatment.=--Since the treatment of severe sprains means first the discrimination between dislocation, a break of bone, and a rupture of muscle, ligament, or tendon, it follows that the methods herein described for treatment should only be employed in slight unmistakable sprains, or until a surgeon can be secured, or when one is unavailable. Nothing is better than immediate immersion of the sprained joint in as hot water as the hand can bear for half an hour.

Following this, an elastic bandage of flannel cut on the bias about three and one-half inches wide should be snugly applied to the limb, beginning at the finger tips or at the toes and carrying the bandage some distance above the injured joint.

In bandaging a part there is always danger of applying the bandage too tightly, especially if the parts swell under the bandage. If this happens, there is increase of pain which may be followed by numbness of the limb and, what is still more significant, coldness and blueness of the extremities below the bandage, particularly of the fingers and toes. In such cases the bandage must be removed and reapplied with less force. If the ankle or knee be sprained the patient must go to bed for at least twenty-four hours, and give the limb a complete rest.

When the wrist or shoulder is sprained the arm should be confined in a sling. In the more serious cases the injured joint should be fixed in a splint before bandaging. An injured elbow joint is held at a right angle by a pasteboard splint, a bandage, and a sling, while the knee and wrist are treated with the limb in a straight line, as far as possible.

In the case of the knee, the splint is applied to the back of the leg; in sprained wrist, to the palm of the hand and same side of the forearm. Sheet wadding, which may be bought at any drygoods store, is torn into strips about two inches wide and sewed together forming a bandage ten or fifteen feet long, and this is first wound about the sprained joint. Then pieces of millboard or heavy pasteboard are soaked in water and applied while wet in long strips about three inches wide over the wadding, and the whole is covered with bandage.

In the case of the knee it is better to use a strip of wood for the splint, reaching from the lower part of the calf to four inches above the knee. It should be from a quarter to half an inch thick, a little narrower than the leg, and be padded thickly with sheet wadding. It is held in place by strips of surgeon's adhesive plaster, about two inches wide, pa.s.sed around the whole circ.u.mference of the limb above and below the knee joint, and covered with bandage.

In ordinary sprains of the ankle, uncomplicated by broken bone or ligament, it is possible for the patient, after resting in bed for a day, to go about on crutches, without bearing any weight on the foot until the third day after the accident. The treatment in the meanwhile consists in immersing the sprained ankle alternately, first in hot water for five minutes and then in cold water for five minutes, followed by rubbing of the parts about the injured joint with chloroform liniment for fifteen minutes, but not at the beginning touching the joint itself. The rubbing should be done by an a.s.sistant very gently the first day, with gradual increase in vigor as the days pa.s.s, not only kneading the ankle but moving the joint.

This treatment should be pursued once daily, and followed by bandaging with a flannel bandage cut on the bias three and a half inches wide.

With this method it is possible for the patient to regain the moderate use of the ankle in about two or three weeks.

The same general line of treatment applies to the other joints; partial rest and daily bathing in hot and cold water, rubbing and movements of the joint by an a.s.sistant. Since sprains vary in severity it follows that some may need only the first day's preliminary treatment prescribed to effect a cure, while others may require fixation by a surgeon in a plaster-of-Paris splint for some time, with additional treatment which only his special knowledge can supply.

[Ill.u.s.tration: This picture shows an excellent method of fixing a sprained joint, used by Prof. Virgil P. Gibney, M.D., Surgeon-in-Chief of the N. Y. Hospital for Ruptured and Crippled. It consists of strapping the joint by means of long, narrow strips of adhesive plaster incasing it immovably in the normal position. This procedure may be followed by anyone who has seen a surgeon practice it.]

=SYNOVITIS--Severe Injury.=--Generally of ankle or knee from fall, or shoulder from blow.

_First Aid Rule 1.--Provide large pitcher of hot water and large pitcher of cold water and basin. Hold joint over basin; pour hot water slowly over joint. Return this water to pitcher. Pour cold water over joint. Return water to pitcher. Repeat with hot water again, and follow with cold. Continue this alternation for half an hour._

_Rule 2.--Put to bed, with hot-water bottles about joint, and wedge immovably with pillows._

_Rule 3.--When tenderness and heat subside, strap with adhesive plaster in overlapping strips._

=Conditions, Etc.=--This condition, which may affect almost any freely movable joints, as the knee, elbow, ankle, and hip, is commonly caused by a wrench, blow, or fall. Occasionally it comes on without any apparent cause, in which case there is swelling and but slight pain or inflammation about the joint. We shall speak of synovitis of the knee ("water on the knee"), as that is the most common form, but these remarks will apply almost as well to the other joints. In severe cases there are considerable pain, redness and heat, and great swelling about the knee. The swelling is seen especially below the kneepan, on each side of the front of the joint, and also often above the kneepan.

Frequently the only signs of trouble are swelling with slight pain, unless the limb is moved.

=Treatment.=--If the knee is not red, hot, or tender to the touch, it will not be necessary for the patient to remain in bed, but when these symptoms are present a splint of some sort must be applied so that the leg is kept nearly straight, and the patient must keep to his bed until the heat, redness, and tenderness have subsided. In the meantime either an ice bag, hot poultice, cloths wrung out in hot water, or a hot-water bag should be kept constantly upon the knee.

A convenient splint consists of heavy pasteboard wet and covered with sheet wadding (or cotton batting) shaped and affixed to the back of the leg, from six inches below to four inches above the joint, by strips of adhesive plaster, as shown in the ill.u.s.tration, and then by bandage, leaving the knee uncovered for applications. A wooden splint well padded may be used instead.

In mild cases without much inflammation, and in others after the tenderness and heat have abated, the patient may go about if the knee is treated as follows: a pad of sheet wadding or cotton batting about two inches thick and five inches long and as wide as the limb is placed in the hollow behind the knee, and then the whole leg is encircled with sheet wadding from six inches below to four inches above the knee, covering the joint as well as the pad. Beginning now five inches below the joint, strips of surgeon's adhesive plaster, an inch wide and long enough to more than encircle the limb, are affixed about the leg firmly like garters so as to make considerable pressure.

Each strip or garter overlaps the one below about one-third of an inch, and the whole limb is thus incased in plaster from five inches below the knee to a point about four inches above the joint.

An ordinary cotton bandage is then applied from below over the entire plaster bandage. When this arrangement loosens, the plaster should be taken off and new reapplied, or a few strips may be wound about the old plaster to reenforce it. The patient may walk about with this appliance without bending the knee.

When the swelling has nearly departed, the plaster may be removed and the knee rubbed twice daily about the joint and the joint itself moved to and fro gently by an attendant, and then bandaged with a flannel bandage. Painting the knee with tincture of iodine in spots as large as a silver dollar is also of service at this time. The knee should not be bent in walking until it can be moved by another person without producing discomfort.

Such treatment may be applied to the other joints in a general way.

The elbow must be fixed by a splint as recommended for dislocation of the joint (p. 128). The ankle is treated as advised for sprain of that joint (p. 68). When a physician can be obtained no layman is justified in attempting to treat a case of water on the knee or similar affection of other joints.

=BUNION AND HOUSEMAID'S KNEE.=--Bunion is a swelling of the bursa, or cushion, at the first joint of the great toe where it joins the foot.

It may not give much trouble, or it may be hot, red, tender, and very painful. It is caused by pressure of a tight boot which also forces the great toe toward the little toe, and thus makes the great toe joint more prominent and so the more readily injured.

A somewhat similar swelling, often as large as an egg, is sometimes seen over the kneepan, more often in those who work upon their knees, hence the name housemaid's knee. The swelling may come on suddenly and be hot, tender, and painful, or it may be slow in appearing and give little pain.

=Treatment.=--The treatment for the painful variety of bunion and housemaid's knee is much the same: absolute rest with the foot kept raised, and application of cloths kept constantly wet with ice or cold water; or a thick covering of Cataplasma Kaolini (U. S. P.) may be applied until the inflammation has subsided. If the trouble is chronic, or the acute inflammation does not soon abate under the treatment advised, the case is one for the surgeon, and sometimes requires the knife for abscess formation. In the milder cases of bunion, wearing proper shoes whose inner border forms almost a straight line from heel to toe, so that the great toe is not pushed over toward the little toe, and painting the bunion every few days with tincture of iodine, until the skin begins to become sore, will often be sufficient to secure recovery.

=RUN-AROUND; WHITLOW OR FELON.=--"Run-around" consists in an inflammation of the soft parts about the finger nail. It is more common in the weak, but may occur in anyone, owing to the entrance of pus germs through a slight p.r.i.c.k or abrasion which may pa.s.s unnoticed.

The condition begins with redness, heat, tenderness, swelling, and pain of the flesh at the root of the nail, which extends all about the nail and may be slight and soon subside, or there may be great pain and increased swelling, with the formation of "matter" (pus), and result in the loss of the nail, particularly in the weak.

Whitlow or felon is a much more serious trouble. It begins generally as a painful swelling of one of the last joints of the fingers on the palm side. Among the causes are a blow, scratch, or puncture. Often there is no apparent cause, but in some manner the germs of inflammation gain entrance. The end of the finger becomes hot and tense, and throbs with sometimes almost unbearable pain. If the inflammation is chiefly of the surface there may be much redness, but if mainly of the deeper parts the skin may be but little reddened or the surface may be actually pale. There is usually some fever, and the pain is made worse by permitting the hand to hang down. If the felon is on the little finger or thumb the inflammation is likely to extend down into the palm of the hand, and from thence into the arm along the course of the tendons or sinews of the muscles. Death of the bone of the last finger joint necessitating removal of this part, stiffness, crippling, and distortion of the hand, or death from blood poisoning may ensue if prompt surgical treatment is not obtained.

=Treatment.=--At the very outset it may be possible to stop the progress of the felon by keeping the finger constantly wet by means of a bandage continually saturated with equal parts of alcohol and water, at night keeping it moist by covering with a piece of oil silk or rubber. Tincture of iodine painted all over the end of the finger is also useful, and the hand should be carried in a sling by day, and slung above the head to the headboard of the bed by night. If after twenty-four hours the pain increases, it is best to apply hot poultices to the finger, changing them as often as they cool. If the felon has not begun to abate by the end of forty-eight hours, the end of the finger must be cut lengthwise right down to the bone by a surgeon to prevent death of the bone or extension of the inflammation.

Poultices are then continued.

"Run-around" is treated also by iodine, cold applications, and, if inflammation continues, by hot poulticing and incision with a knife; but poulticing is often sufficient. Attention to the general health by a physician will frequently be of service.