before the arrival of a doctor, except to keep it perfectly at rest,
unless the patient must be moved; then, to prevent further mischief,
the broken ends of the bone _must_ be put in position and kept there.
The first step is to pull the limb till the sinews and muscles
stretch sufficiently to let the two ends of the bone meet each other.
When this has been done, splints and bandages must be applied to keep
the ends from shifting again.
The treatment of a broken bone then consists of (1) carefully
removing or cutting away, if more convenient, any of the clothes
which are compressing or hurting the injured parts; (2) very gently
replacing the bones in their natural position and shape, as nearly as
possible, and putting the part in a position which gives most ease to
the patient; (3) applying some temporary splint or appliance, which
will keep the broken bones from moving about and tearing the flesh,
for which purpose you may use pieces of wood, stick, tin, pasteboard,
wire, straw, or firmly folded cloth, taking care to pad the splints
with some soft material, and not to apply them too tightly, while the
splints may be tied by loops of rope, string, pockethandkerchiefs,
pieces of cloth, or any kind of cord; (4) conveying the patient home
or to a hospital, meanwhile examining the loops to see that they do
not become too tight by rapid swelling of the part.
To get at a broken limb or rib, the clothing must be removed, and it
is essential that this be done without injury to the patient. The
simplest plan is to rip up the seams of such garments as are in the
way. Boots must be cut off.
In a fracture of a leg bone, after setting the broken limb and
putting it in splints, it should be bound to the sound leg at the
knee and ankle, with rolled up coat for the sides and a piece of thin
board or other substance for the front of the thigh. A broken arm,
when in splints, requires the support of a sling, which may be made
of a handkerchief fastened round the neck.
Bandaging can hardly be learned from a book--some practice is
essential. Bandages are made of unbleached calico, flannel, linen,
&c., and are used as supports to the different parts of the body, as
means of applying pressure, for fixing splints, dressing, &c., and
for allaying muscular action. The chief kinds are the roller and the
triangular bandages.
Roller bandages commonly have the following dimensions: Finger, 1
yd. by ¾ in.; arm, 3-6 yd. by 2½ in.; leg, 6-8 yd. by 3 in.; chest,
8-12 yd. by 4-5 in.; head, 4-6 yd. by 2½ in. To roll one of these
bandages, first fold one end 2 or 3 times, as tightly as you can,
making it into a small roll; take hold of this by the fingers of
both hands, both thumbs being placed on the top of it, the rest of
the bandage being held by another person, who keeps it moderately
strained; by alternate movement of the thumbs make the roll revolve
on its own axis, the fingers at the same time holding it in position
between the hands; fasten the end by a stitch or pin, to prevent
unrolling.
[Illustration: 112. 113. Simple Spiral Bandage. 114. Reversed Spiral
Bandage.]
Roller bandages are applied in 3 different ways: (1) simple spiral,
(2) reverse or recurrent, (3) crucial or figure-of-8. When first
applying the bandage, leave the end a little long, so that when the
first turn is made, by laying this end under, and bandaging over
it again, it is prevented from slipping. The application of the
simple spiral is shown in Figs. 112, 113, each turn overlapping the
preceding one to the extent of about ⅔rds the width of the bandage.
This simple spiral is generally replaced by the reverse spiral, Fig.
114, which differs from it in that the bandage is turned back upon
itself each time it is carried round the limb; it is not easily
learnt, and requires practice before it can be done well; the thumb
or forefinger of the hand not holding the bandage should be laid
upon the limb at the point where the turn of the bandage is to be
commenced, the other hand turning the bandage back upon itself. The
crucial or figure-of-8 form is generally used at the joints, and
always when going over the ankle-joint in bandaging from the foot up
the leg. Carry the bandage over the upper part of the joint, then
down, under, and across the lower part, and then up over the upper
part again. Remember always to bandage from within outwards; commence
from below and work upwards; let the pressure be evenly and uniformly
applied, but not too lightly; avoid all wrinkles in your bandage;
reverse or turn a bandage over always on the fleshy side, and not
over a bone; fasten it with a few stitches.
[Illustration: _d_ Triangular Bandage on Foot.]
The triangular bandage may well be represented in every-day life by
an ordinary large pockethandkerchief folded from corner to corner.
Its application is almost endless and simplicity itself. A few
examples of the manner in which it may be used are shown in Figs.
115, _a_, _b_, _c_, _d_; it is fastened merely by tying the ends in a
double knot.
[Illustration: 115. _a b c_ Application of Triangular Bandage.]
Broken ribs are of common occurrence, and give rise to great pain,
because every time the injured person breathes, the ribs, rising
and falling, allow the broken ends to grate against each other. A
temporary method of relieving this pain and keeping the broken ends
in apposition, is to roll a wide flannel or calico bandage tightly
round the chest 3 or 4 times.
_Burns and Scalds._--(_a_) In all but very slight cases of burns
and scalds, the patient should be seen by a doctor at once, as the
constitutional symptoms consequent upon these accidents require
skilled attention. With regard to the immediate local applications.
The clothes having been most gently and cautiously removed (being cut
in all places where they adhere to the burnt and scalded skin) and
any blisters having been simply pricked, the surface should at once
be covered with some unirritating substance which excludes the air
and keeps up a good heat. For this purpose many things are advocated,
such as flour, starch, a mixture of collodion and castor oil, and
“carron oil” (equal parts lime-water and linseed oil). A smooth,
thick layer of cotton wool should be laid over this, or failing that
a blanket, but do not let the blanket touch any raw place without the
intervention of a piece of fine linen rag soaked in oil, or it would
stick, causing great pain when removed.
(_b_) Linen dipped in a solution of carbonate of soda or potash
relieves the pain sooner than anything. The best form is a saturated
solution of bicarbonated soda in either plain water or camphorated
water; if applied speedily it is most effectual in immediately
relieving the acute burning pain; and when the burn is only
superficial, or not severe, removing all pain in the course of a
very short time, and preventing the usual consequences--a painful
blistering of the skin, separation of the epidermis, and perhaps more
or less of suppuration. For this purpose, all that is necessary is to
cut a piece of lint, or old soft rag, or even thick blotting-paper,
of a size sufficient to cover the burned or scalded parts, and to
keep it constantly well wetted with the soda lotion so as to prevent
its drying. By this means, it usually happens that all pain ceases
in ¼-½ hour. Where the main part of a limb, such as the hand and
fore-arm or the foot and leg have been burned, it is best to plunge
the part at once into a vessel filled with the soda lotion, and keep
it there until the pain subsides.
(_c_) The matter given off from burnt surfaces soon emits a very
offensive odour. Therefore it is wise to mix an antiseptic substance
with the remedies--e.g. carbolic acid or thymol, which not only
prevent the bad odour from the suppuration, but also tend to
alleviate the suffering. It would be well to always keep ready mixed
an ointment for burns containing 1 per cent. thymol.
(_d_) The free use of soft soap upon a fresh burn will remove the
fire from the flesh in very little time. If the burn be severe, after
relief from the pain, use linseed oil, and then sift upon it wheat
flour. When this is dried hard, repeat the oil and flour until a
complete covering is obtained. Let this dry until it falls off, and a
new skin will be formed without a scar.
(_e_) Take ice well crushed or scraped, as dry as possible, into the
finest division; then mix it with fresh lard until a broken paste is
formed. The mass is put into a thin cambric bag, laid upon the burn
or scald, and replaced as required. So long as the ice and lard are
melting there is no pain from the burn; return of pain calls for the
repetition of the remedy.
(_f_) Whether the skin is broken or not, apply soft cotton or linen
rags, dipped in a solution of Epsom salts, 1 oz. to the pint of cold
water, and lightly bound over the burnt part or parts, the bandages
to be kept constantly moist with the solution, and never removed till
a cure is effected, which will be in 2-3 hours to 2-3 days, according
to the severity and extent of the burning. While this application in
all cases gives instant relief from pain, it is especially useful in
removing the tendency to collapse and nervous dread.
(_g_) Cover the place over at once with the preparation of chalk,
called common kitchen whiting, mixed, either with sweet oil or
water--oil is preferable--into a thick paste. Plaster it gently on
with a brush or a feather about ⅛ in., or more, thick; taking care,
if possible, not to break the blister, or blisters. Then cover the
part affected with a piece of flannel, to keep the moisture in, and
damp the layer of whiting from time to time with oil or water. If
kitchen whiting cannot be procured, use flour instead; and if neither
can be had, then cover the scalds or burns with bits of rag dipped
in sweet oil, and lay plenty of cotton wool outside them. Change the
dressings only often enough to keep the places clean, and then wash
them off with a weak solution of carbolic acid.
(_h_) A method in use in the public hospitals of the city of New
York, known as “glue burn mixture” is composed as follows 7½ troy
oz. white glue, 16 fl. oz. water, 1 fl. oz. glycerine, 2 fl. dr.
carbolic acid. Soak the glue in the water until it is soft; then heat
on a water-bath until melted; add the glycerine and carbolic acid,
and continue heating until, in the intervals of stirring, a glossy,
strong skin begins to form over the surface. When wanted for use,
heat on a water-bath, and apply with a flat brush over the burned
part. Pour the melted mass into small delf extract jars, cover with
paraffin-paper and tin-foil before the lid is put on, and afterwards
protect by paper pasted around the edge of the lid. In this manner,
the mass may be preserved indefinitely.
(_i_) Saturate a soft piece of fabric with alcohol, lay it over the
burn, then cover it with cotton or finely picked oakum: it will
allay the pain. Subsequently disturb the dressing as little as
possible; wet the dressing occasionally with alcohol. In burns from
strong nitric acid, copious application of cold water, and even of
such powerful bases as ammonia, potash, and lime in water, have no
perceptible effect, except perhaps to increase the violence of the
inflammation. But the effect of a dilute solution of sulphurous acid
is astounding. In a very few minutes the blister will be reduced;
the oxidising process of the acid will be completely arrested, the
painful irritation removed, and in a short space of time the wound
will heal. (A. Irving.)
In bad burns with lime, soap lye, or any caustic alkali, wash
abundantly with water (do not rub), and then with weak vinegar or
water containing a little sulphuric acid; finally apply oil as in
ordinary burns.
(_j_) To recover a person in a state of insensibility from the
effect of smoke, dash cold water in the face, or cold and hot water
alternately. Should this fail, turn him on his face, with the
arms folded under his forehead. Apply pressure along the back and
ribs, and turn the body gradually on the side; then again slowly
on the face, repeating the pressure on the back. Persevere with
these alternate rolling movements about 16 times in a minute, until
respiration is restored, A warm bath will now complete the recovery.
(_k_) In scalding by boiling water or steam, cold water should be
plentifully poured over the person and cloths, and the patient then
be carried carefully to a warm room, laid on the floor or carpet,
or on a table, but not put into bed (as there it becomes difficult
to attend further to the injuries), to await the doctor. If the
patient complains of thirst, a warm, stimulating drink (such as tea)
should be given, as after severe burning the temperature of the
body is sure to fall. Children sometimes receive serious scalds of
the mouth and throat by swallowing hot fluid or steam from a spout.
Medical assistance should be obtained without delay, as an immediate
operation may be required to prevent death from suffocation. Until
the arrival of the doctor the patient should inhale warm vapour, to
relieve the fits of choking; the best way to make a person inhale
vapour is to construct a kind of tent of blankets around the patient,
and allow the steam from a kettle, to puff into it.
[Illustration: 116. Supporting patient.]
_Carrying injured persons._ (_a_) By Bearers.--If no conveyance can
be procured or improvised, you can transport an injured person a
short distance by human bearers. If only one is available, and if the
patient can stand up, let him place one arm round the neck of the
bearer, bringing his hand on and in front of the opposite shoulder
of the bearer. The bearer then places his arm behind the back of the
patient and grasps his opposite hip, at the same time catching firmly
hold of the hand of the patient placed on his shoulder with his other
hand. Then by putting his hip behind the near hip of the patient much
support is given, and, if necessary, the bearer can in this way lift
him off the ground, and, as it were, carry him along. This is an
admirable way of helping an invalid to walk up stairs. If the patient
cannot stand, the only way in which one person can remove him is by
getting him on his back; this is not practicable in a case of broken
thigh (Fig. 116).
[Illustration: 117. 118. 119. Methods of carrying a helpless patient.]
When 2 bearers are available, the patient may be carried several
different ways:--(1) In a sitting position, by the bearers joining
two of their hands underneath his thighs, close to the buttocks,
while their other two hands are placed round his loins and clasped
together. The patient, if able, can help to support himself by
clasping the bearers round their necks. (2) By 2 of the bearers’
hands forming a seat and the other 2 arms a back support (Fig. 117).
(3) By 3 of their hands forming a seat, while a back support is made
by the remaining arm (Fig. 118). (4) A seat may be made with all
4 hands, and especially if the patient is able to sit up and help
support himself by placing his arm over the shoulders of the bearers,
he may be carried a long distance by this method. Fig. 119 shows
another plan, and Fig. 120 indicates how the hands should grasp each
other.
[Illustration: 120. Forming a seat.]
(_b_) By Stretcher.--To place an injured person on a stretcher and
convey him properly requires 3 bearers, unless the distance be very
great; 2 carry the stretcher, and a third attends to the patient,
and changes place with one of the bearers if necessary. To lay a
patient on it, put the foot of the stretcher at his head in a line
with his body; 2 bearers then place themselves one at either side,
join hands underneath the back and hips of the patient, raise him up,
lift him backwards over the stretcher, and lower him on to it. The
third bearer takes charge of the injured portion (limb or head),
and steadies it with a hand on either side. The two bearers now take
their places at the head and foot of the stretcher, lift it up, and
carry it off; while the third walks at the side of it, as a safeguard
to the patient. Observe the following rules in carrying a stretcher:
(1) Carry it with the hands, or suspended by straps over the bearers’
shoulders, never place it on the shoulders, because the patient might
fall off, or even die, without the bearer observing it. (2) Do not
keep step, i.e. do not put the same foot forward, then the motion of
the stretcher remains even. The pace must be short (about 20 in.) and
without a spring; the knees must be rather bent, and the hips moved
as little as possible. Jolting, hurrying, crossing ditches, &c.,
are to be avoided. Choose bearers of the same height, arrange the
shoulder-straps so that the head may be carried a little higher than
the feet.
_Convulsions._--Till medical aid can be procured, put the child into
a warm bath, in which you can bear your elbow. Sponge him well over,
and put a sponge of cold water on his head.
_Cuts and Wounds._--Wounds may be “incised” (made by a clean-cutting
instrument), “punctured” (when the depth exceeds the breadth, as in
stabs), “lacerated” (torn, and the lips of the wound irregular), and
“contused” (effected by bruising). The chief points to be attended
to are:--(_a_) Arrest the bleeding. (_b_) Remove all foreign bodies
as soon as possible. (_c_) Bring the wounded parts in apposition,
and keep them so, best done by means of strips of adhesive plaister,
first applied to one side of the wound, and then secured to the
other; these strips should not be too broad, and space must be
left between the strips to allow any matter to escape; wounds too
extensive to be kept together by plaister, must be stitched by a
surgeon. For punctured and severely lacerated or contused wounds a
surgeon should be sent for.
For washing a wound, to every pint of water add either 5 gr.
corrosive sublimate or 2½ teaspoonfuls carbolic acid. If the acid
is used, add 2 tablespoonfuls glycerine, to prevent its irritating
the wound. If there is neither of these articles in the house, add
4 tablespoonfuls borax to the water. Wash the wound, close it, and
apply a compress of a folded square of cotton or linen. Wet it in the
solution used for washing the wound, and bandage down quickly and
firmly. If the bleeding is profuse, a sponge dipped in very hot water
and wrung out in cloth should be applied as quickly as possible. If
this is not available, use ice, or cloths wrung out in ice water.
Wounds heal in two ways.--(_a_) Rapidly, by primary union without
suppuration, and leaving only a very fine scar; this only when
the sides of wound can be accurately brought together, are not
displaced by bleeding or exudation of matter, and when the wound is
left quiet, protected from outward injury, and kept perfectly free
from impurity. (_b_) Slowly, with suppuration, and the formation of
granulations, and leaving a large red scar, as when so much skin
has been destroyed that the edges of the wound cannot be brought
together, or so lacerated and bruised that life is destroyed in them,
or separated by blood or exudation of matter, or if the injured parts
have been disturbed, or the wound has not been properly cleaned
and disinfected. Want of cleanliness leads to putrefaction and the
formation of matter, which separates the sides of the wound.
_Drowning, Choking, and Suffocation._--The fatal termination to be
avoided in all these cases is suspension of breathing, hence they may
be classed under one head.
Drowning.--This is perhaps the most common, and embraces in great
measure the remedies adapted to the other forms of suffocation. The
first step is to send immediately for medical assistance, blankets,
and dry clothing; but proceed to treat the patient _instantly_ on
the spot, in the open air, with the face downward, whether on shore
or afloat; exposing the face, neck, and chest to the wind, except in
severe weather, and removing all tight clothing from the neck and
chest, especially the braces.
The points to be aimed at are--_immediately_ the restoration of
breathing; and, after breathing is restored, promotion of warmth
and circulation. Efforts to restore breathing must be commenced
immediately and energetically, and persevered in for 1-2 hours, or
until a doctor has pronounced life extinct. Efforts to promote warmth
and circulation, beyond removing wet clothes and drying the skin,
must not be made until the first appearance of natural breathing;
for if circulation of the blood be induced before breathing has
recommenced, the restoration to life will be endangered.
To restore breathing, place the patient on the floor or ground with
the face downwards, and one of the arms under the forehead, in which
position fluids can more readily escape at the mouth, and the tongue
will loll out, leaving the entrance to the windpipe free. The tongue
may be easily kept extended by simply passing a small rubber band
round it and the chin. The mouth and nose must be thoroughly wiped
and cleaned from obstructions.
If breathing has quite or almost failed, means must be used to
restore it; if not, proceed at once to promote warmth. There are
several ways of inciting suspended respiration. The best, as
requiring only one person, is Silvester’s method, as follows: Place
the apparently dead person flat on his back, raising his head and
shoulders slightly by means of a folded article of dress. Standing
behind him, grasp his arms just above the elbow, and draw them gently
and steadily upwards over the head, keeping them in that position
for 2 seconds; by this means the chest expands and air is drawn into
the lungs (Fig. 121). Then carry the arms back again in the same way
and press them gently and firmly against the sides of the chest for
2 seconds; by this means the air is pressed out of the lungs again
(Fig. 122). These movements are repeated carefully and perseveringly,
about 15 times in a minute, till natural respiration begins. The
first evidence of this is a sudden flush of colour in the face.
[Illustration: 121. Inspiration (Silvester). 122. Expiration
(Silvester).]
When 2 persons are present, Francis’s plan may be adopted, thus: The
body of the patient is laid on the back, with clothes loosened, and
the mouth and nose wiped; 2 bystanders pass their right hands under
the body at the level of the waist, and grasp each other’s hands,
then raise the body until the tips of the fingers and the toes of the
patient alone touch the ground; count 15 rapidly; then lower the body
flat to the ground, and press the elbows to the side hard; count 15
again; then raise the body again for the same length of time, and so
on, alternately raising and lowering. The head, arms, and legs are to
be allowed to dangle down quite freely when the body is raised.
When 3 or more persons can assist, Marshall Hall’s method is
available. To excite breathing, turn the patient quite on the side,
supporting the head, and induce inspiration and expiration by
alternately rolling the body over on its face, and back again, at 15
seconds intervals, as shown in Figs. 123 and 124.
[Illustration: 123. Inspiration (Marshall Hall). 124. Expiration
(Marshall Hall).]
As soon as a natural effort to breathe is produced, endeavour to
restore circulation and warmth. Wrap the body in dry blankets and
commence rubbing the limbs upwards firmly and energetically under
the blanket or over warm clothing, which can generally be got from
bystanders. Then put the patient into a warm bed, and cover over with
hot flannels, applying bottles or bladders of hot water, or heated
bricks, to the pit of the stomach, the armpits, between the thighs,
and to the soles of the feet. When the patient is able to swallow,
give him warm fluids by spoonfuls--coffee, tea, brandy and water,
wine--but not in too great quantities. Warm baths should never be
used but when ordered by the doctor.
Choking.--When a person gets a fish-bone or other substance in the
throat, at once insert a finger into the mouth and press upon the
root of the tongue, so as to induce vomiting. If this fails, let
the patient swallow a piece of soft bread. If the substance can be
felt by the finger, insert 2 fingers into the mouth and bring it
away, using the safeguard of putting some hard substance between the
teeth. A medical man should at once be sent for. Repeatedly sucking
lemons will help to dissolve the bone. A marble or similar article in
a child’s throat may be dislodged by turning him heels upwards and
shaking.