The Home Medical Library Volume I Part 5

=WEEPING SINEW; GANGLION.=--This is a swelling as large as a large bean projecting from the back or front of the wrist with an elastic or hard feeling, and not painful or tender unless pressed on very hard.

After certain movements of the hand, as in playing the piano or, for example, in playing tennis, some discomfort may be felt. Weeping sinew sometimes interferes with some of the finer movements of the hand.

The swelling is not red or inflamed, but of the natural color of the skin. It does not continue to increase after reaching a moderate size, but usually persists indefinitely, although occasionally disappearing without treatment. The swelling contains a gelatinous substance which is held in a little sac in the sheath of the tendon or sinew, but the inside of the sac does not communicate with the interior of the sheath surrounding the tendon.

=Treatment.=--This consists in suddenly exerting great pressure on the swelling with the thumb, or in striking it a sharp blow with a book by which the sac is broken. Its contents escape under the skin, and in most cases become absorbed. If the swelling returns a very slight surgical operation will permanently cure the trouble.

=CINDERS AND OTHER FOREIGN BODIES IN THE EYE.=[4]--Foreign bodies are most frequently lodged on the under surface of the upper lid, although the surface of the eyeball and the inner aspect of the lower lid should also be carefully inspected. A drop of a two per cent solution of cocaine will render painless the manipulations. The patient should be directed to continue looking downward, and the lashes and edge of the lid are grasped by the forefinger and thumb of the right hand, while a very small pencil is gently pressed against the upper part of the lid, and the lower part is lifted outward and upward against the pencil so that it is turned inside out. The lid may be kept in this position by a little pressure on the lashes, while the cinder, or whatever foreign body it may be, is removed by gently sweeping it off the mucous membrane with a fold of a soft, clean handkerchief. (See Figs. 6 and 7.)

[Ill.u.s.tration: FIG. 6.

FIG. 7.

REMOVING A FOREIGN BODY FROM THE EYE.

In Fig. 6 note how lashes and edge of lid are grasped by forefinger and thumb, also pencil placed against lid; in Fig. 7 lid is shown turned inside out over pencil.]

Hot cinders and pieces of metal may become so deeply lodged in the surface of the eye that they cannot be removed by the method recommended, or by using a narrow slip of clean white blotting-paper.

All such cases should be very speedily referred to a physician, and the use of needles or other instruments should not be attempted by a layman, lest permanent damage be done to the cornea and opacity result. Such procedures are, of course, appropriate for an oculist, but when it is impossible to secure medical aid for days it can be attempted without much fear, if done carefully, as more harm will result if the offending body is left in place. It is surprising to see what a hole in the surface of the eye will fill up in a few days. If the foreign body has caused a good deal of irritation before its removal, it is best to drop into the eye a solution of boric acid (ten grains to the ounce of water) four times daily.

=FOREIGN BODIES IN THE EAR.=--Foreign bodies, as b.u.t.tons, pebbles, beans, cherry stones, coffee, etc., are frequently placed in the ear by children, and insects sometimes find their way into the ear pa.s.sage and create tremendous distress by their struggles. Smooth, nonirritating bodies, as b.u.t.tons, pebbles, etc., do no particular harm for a long time, and may remain unnoticed for years. But the most serious damage not infrequently results from unskillful attempts at their removal by persons (even physicians unused to instrumental work on the ear) who are driven to immediate and violent action on the false supposition that instant interference is called for. Insects, it is true, should be killed without delay by dropping into the ear sweet oil, castor, linseed, or machine oil or glycerin, or even water, if the others are not at hand, and then the insect should be removed in half an hour by syringing as recommended for wax (Vol. II, p. 35).

To remove solid bodies, turn the ear containing the body downward, pull it outward and backward, and rub the skin just in front of the opening into the ear with the other hand, and the object may fall out.

Failing in this, syringing with warm water, as for removal of wax, while the patient is sitting, may prove successful. The essentials of treatment then consist, first, in keeping cool; then in killing insects by dropping oil or water into the ear, and, if syringing proves ineffective, in using no instrumental methods in an attempt to remove the foreign body, but in awaiting such time as skilled medical services can be obtained. If beans or seeds are not washed out by syringing, the water may cause them to swell and produce pain. To obviate this, drop glycerin in the ear which absorbs water, and will thus shrivel the seed.

=FOREIGN BODIES IN THE NOSE.=--Children often put foreign bodies in their noses, as shoe b.u.t.tons, beans, and pebbles. They may not tell of it, and the most conspicuous symptoms are the appearance of a thick discharge from one nostril, having a bad odor, and some obstruction to breathing on the same side. If the foreign body can be seen, the nostril on the un.o.bstructed side should be closed and the child made to blow out of the other one. If blowing does not remove the body it is best to secure medical aid very speedily.

FOOTNOTES:

[4] The Editors have deemed it advisable to repeat here the following instructions, also occurring in Vol. II, Part I, for the removal of foreign bodies in the eye, ear, and nose, as properly coming under the head of "First Aid in Emergencies."

CHAPTER IV

=Fractures=

_How to Tell a Broken Bone--A Simple Sling--Splints and Bandage,--A Broken Rib--Fractures of Arm, Shoulder, Hand, Hips Leg and Other Parts._

=BROKEN BONE; FRACTURE.=[5]

_First Aid Rule 1.--Be sure bone is broken. If broken, patient can scarcely (if at all) move the part beyond the break, while attendant can move it freely in his hands. If broken, grating of rough edges of bone may be felt by attendant but should not be sought for. If broken, limb is generally shortened._

_Rule 2.--Do not try to set bone permanently. Send at once for surgeon._

=COMPOUND FRACTURE.=

_Important. If there is opening to the air from the break, because of tearing of tissues by end of bone, condition is very dangerous; first treatment may save life, by preventing infection. Before reducing fracture, and without stirring the patient much, after scrubbing your hands very clean, note:_

_First Aid Rule 1.--If hairy, shave large spot about wound._

_Rule 2.--Clean large area about wound with soap and water, very gently. Then wash most thoroughly again with clean water, previously boiled and cooled. Flood wound with cool boiled water._

_Rule 3.--Cover wound with absorbent cotton (or pieces of muslin) which has been boiled. Then attend to broken bone, as hereafter directed, in the case of each variety of fracture._

_After the bone is set, according to directions, then note:_

_Rule 4.--Renew pieces of previously boiled muslin from time to time, when at all stained with discharges. Every day wash carefully about wound, between the splints, with cool carbolic-acid solution (one teaspoonful to a pint of hot water) before putting on the fresh cloths._

=BROKEN BONES OR FRACTURES.=[6]--It frequently happens that the first treatment of fracture devolves upon the inexperienced layman.

Immediate treatment is not essential, in so far as the repair of the fracture is directly concerned, for a broken bone does not unite for several weeks, and if a fracture were not seen by the surgeon for a week after its occurrence, no harm would be done, provided that the limb were kept quiet in fair position until that time. The object of immediate care of a broken bone is to prevent pain and avoid damage which would ensue if the sharp ends of the broken bone were allowed to injure the soft tissues during movements of the broken limb.

Fractures are partial or complete, the former when the bone is broken only part way through; simple, when the fracture is a mere break of the bone, and compound, when the end of one or both fragments push through the skin, allowing the air with its germs to come in contact with the wound, thus greatly increasing the danger. To be sure that a bone is broken we must consider several points. The patient has usually fallen or has received a severe blow upon the part. This is not necessarily true, for old people often break the thigh bone at the hip joint by simply making a false step.

Inability to use the limb and pain first call our attention to a broken bone. Then when we examine the seat of injury we usually notice some deformity--the limb or bone is out of line, and there may be an unusual swelling. But to distinguish this condition from sprain or bruise, we must find that there is a new joint in the course of the bone where there ought not to be any; e. g., if the leg were broken midway between the knee and ankle, we should feel that there was apparently a new joint at this place, that there was increased capacity for movement in the middle of the leg, and perhaps the ends of the fragments of bones could be heard or felt grating together.

These, then, are the absolute tests of a broken bone--unusual mobility (or capacity for movement) in the course of the bone, and grating of the broken fragments together. The last will not occur, of course, unless the fragments happen to lie so that they touch each other and should not be sought for. In the case of limbs, sudden shortening of the broken member from overlapping of the fragments is a sure sign.

=SPECIAL FRACTURES.=

=BROKEN RIB.=--_First Aid Rule.--Patient puts hands on head while attendant puts adhesive-plaster band, one foot wide, around injured side from spine over breastbone to line of armpit of sound side. Then put patient to bed._

A rib is usually broken by direct violence. The symptoms are pain on taking a deep breath, or on coughing, together with a small, very tender point. The deformity is not usually great, if, indeed, any exists, so that nothing in the external appearance may call the attention to fracture. Grating between the fragments may be heard by the patient or by the examiner, and the patient can often place his finger on the exact location of the break.

When it is a matter of doubt whether a rib is broken or not the treatment for broken rib should be followed for relief of pain.

[Ill.u.s.tration: FIG. 8.

METHOD OF BANDAGING BROKEN RIB (SCUDDER).

Note manner of sticking one end of wide adhesive plaster along backbone; also a.s.sistant carrying strip around injured side.]

=Treatment= consists in applying a wide band of surgeon's adhesive plaster, to be obtained at any drug shop. The band is made by overlapping strips four or five inches wide, till a width of one foot is obtained. This is then applied by sticking one end along the back bone and carrying it forward around the injured side of the chest over the breastbone as far as a line below the armpit on the uninjured side of the chest, i. e., three-quarters way about the chest. These four- or five-inch strips of plaster may be cut the right length first and laid together, overlapping about two inches, and put on as a whole, or, what is easier, each strip may be put on separately, beginning at the spine, five inches below the fracture, and continuing to apply the strips, overlapping each other about two inches, until the band is made to extend to about five inches above the point of fracture, all the strips ending in the line of the armpit of the uninjured side.

(Fig. 8.)

If surgeon's plaster cannot be obtained, a strong unbleached cotton or flannel bandage, a foot wide, should be placed all around the chest and fastened as snugly as possible with safety pins, in order to limit the motion of the chest wall. The patient will often be more comfortable sitting up, and should take care not to be exposed to cold or wet for some weeks, as pleurisy or pneumonia may follow. Three weeks are required for firm union to be established in broken ribs.

=COLLAR-BONE FRACTURE.=

_First Aid Rule.--Put patient flat on back, on level bed, with small pillow between his shoulders; place forearm of injured side across chest, and retain it so with bandage about chest and arm._