BACKWOODS SURGERY
BACKWOODS
SURGERY &
MEDICINE
BY
CHARLES STUART MOODY, M. D.
MCMX
OUTING PUBLISHING COMPANY
NEW YORK
COPYRIGHT, 1910, BY
OUTING PUBLISHING COMPANY
_Entered at Stationer's Hall, London, Eng.
All rights reserved_
CONTENTS
CHAPTER PAGE
I. How to Treat Fractures, Sprains
and Dislocations 9
II. Caring for Burns, Cuts, Drowning,
and Minor Accidents 29
III. Medical Treatment of Camp
Diseases 51
IV. Serpent Wounds and Their
Treatment 73
The Camper's Medicine Chest 93
HOW TO TREAT FRACTURES,
SPRAINS AND DISLOCATIONS
Backwoods Surgery and Medicine
CHAPTER I
HOW TO TREAT FRACTURES, SPRAINS AND DISLOCATIONS
Several years ago I stood beside a cot in a hunter's cabin in the heart
of the Bitter Root Mountains in Idaho, after a three days' ride, and
watched a valuable young life go out as the result of an unattended
compound fracture of the thigh. At another time I amputated a leg to
prevent the spread of gangrene from a simple cut across the instep
while the camper was splitting wood, an accident which, properly
treated, would have resulted at most only in a slight inconvenience.
Once again, I transformed my boat into a funeral barge and conveyed a
young man who had only been in the water three minutes back to his
sorrowing parents dead, because his companions were ignorant of how to
resuscitate him.
These and many other instances that have come under my observation
of the sacrifice of lives from trivial causes, owing to a lack of
knowledge, have impressed me with the value of a few suggestions on how
to treat the commoner injuries and diseases that may befall those who
seek recreation in the remote wilds.
The rules will necessarily be brief and from the nature of things
easily followed. The woods loafer should learn them and be prepared
whenever the occasion arises. Works on first aid, written ostensibly
for the guidance of the laymen, are apt to presuppose a far greater
supply of surgical necessities than the hunter cares to burden himself
with. It is one thing to apply surgical measures, having at hand
a well-filled emergency bag, and quite another to render the same
assistance with nothing to depend upon but your native adaptability.
My intention is to tell in the plainest and simplest manner possible
how to render intelligent assistance to an injured comrade, using only
the fewest appliances and those of the most primitive character.
These hints are the result of over twenty years of life in the West,
in mining camps, cow camps, logging camps, and in the heart of the
mountains, where people did not have forethought enough to provide
themselves with even a bandage, many times hundreds of miles from where
such things could be obtained.
The most appalling accident that can befall a man isolated from skilled
surgical aid is the fracture of a limb, especially of the leg, and yet
this is one of the commonest of all woods misfortunes.
Before proceeding to the discussion of individual fractures, a brief
consideration of the classification and detection of fractures in
general is necessary. Surgeons divide fractures into: simple, those
where there is a simple separation of the bone without injury to the
flesh; compound, where in addition to the separation of the bone there
is laceration of the flesh and one or both ends of the bone are driven
out through the skin; and comminuted, where the bone is in several
fragments. A comminuted fracture may be either simple or compound,
according as it does or does not penetrate the flesh.
The symptoms of fracture are pain, loss of motion, change of position,
change of contour of the fleshy parts, and most important of all, a
light crackling sound when the limb is moved—crepitation the surgeons
call it.
Pain following an injury that _might_ produce a fracture is not
necessarily proof positive of the existence of a fracture. Pain may and
often does follow a bruise, sprain, or dislocation, in a greater degree
than that following a fracture. Loss of motion, too, is quite as marked
in dislocations and severe sprains as in fractures. Change of contour,
unless in the locality of prominent joints, is quite a valuable sign.
The fractured limb, except in certain rare cases, will show a change in
the appearance of its general outline.
By crepitation is meant that characteristic grating sound produced by
rubbing the two ends of the fractured bone together. It is the one
absolute sign of a fracture, and once heard can never be forgotten. It
may be likened to the sound produced by rubbing two or three coarse
hairs between the finger and thumb.
If a fracture is suspected let the patient himself, or some one for
him, grasp the limb above and below the site of the suspected fracture
and turn it in opposite directions. If a fracture is present it will be
manifested by a distinct grating sound, also by a jarring sensation as
the uneven fragments pass over each other.
A description of all the fractures of the different bones of the
body would be manifestly out of place in a book of this character,
so I shall confine myself to those most liable to be encountered in
the woods—that is, fractures of the leg, thigh, forearm, and arm.
Fractures of the leg or thigh will entail an enforced stay of from four
to six weeks in the woods, or the devising of some means to transport
the patient to a place where he can have proper care, an arduous task
in a country where there are no roads and the trails are difficult. If
a personal experience may be allowed, I will tell how I once treated
a man with fractured thigh and conveyed him with comparatively little
discomfort over sixteen miles of rugged mountain trail and some forty
miles of equally rugged mountain road.
I found the man in a mining camp in the very heart of the higher
mountains, lying in his bunk with a badly fractured thigh. The bone
was separated between the upper and middle third—that is, up toward
the body. The accident had occurred some twenty hours previous and
there was much swelling, which it was necessary to reduce before
anything else could be done. This was accomplished by the application
of cold water by means of strips of blanket, changing the application
as fast as the water became warmed by the body heat.
In the meantime I went out into the timber and felled a small cedar
tree some six inches in diameter. From this I cut a section five feet
in length and removed the bark. Splitting the bark in half, I rounded
up the edges and made a splint for the outside of the limb extending
from the armpit to six inches below the foot. The other half was made
into a similar splint, only shorter, for the inside of the limb,
extending from well up into the groin to a point opposite the outer
splint below the foot.
It was necessary to cut holes in the splints where the bony prominences
came. When all was in readiness and the limb reduced in size, I wrapped
it well in soft cloth, having no absorbent cotton, and applied my
splints. I had a man stand at the feet of the injured man, take hold
of the injured leg, and pull steadily while I manipulated the fracture.
Right here I want to state that it is unnecessary to try to pull a
broken bone out of the socket in order to set a fracture. A persistent
pull of some fifty pounds will soon overcome the contraction of the
muscles and the bone will be replaced. The acting surgeon must at the
same time grasp the limb at the site of the break and knead the two
ends into place. You will know when they are in place by the absence of
inequality at the point of break.
After the bone had been replaced, I placed my splints in position and
bound them on, using strips of sheet torn up for bandages. Any stout
cloth will do as well. They may be placed in the ordinary manner,
each wrap beside the other, or they may be run on in continuous form,
permitting each ascending turn to half overlap the one below it. Care
must be taken that the pressure is equal in all parts of the bandage
and that it is placed tight enough to prevent any slipping of the
splints.
The next problem was to get the man out. Again the cedar forest came
to my relief. I felled another and somewhat larger tree, sufficiently
large to permit placing the injured man in a boat-shaped section of
the bark. This was made longer than his body and a semi-circular board
fitted in each end. When the whole was completed it resembled a rude
trough.
This trough was lined with blankets until it was quite soft. Two poles
twelve feet in length were lashed to either side and the man securely
lashed in the contrivance. When we were ready to start two steady pack
animals were brought out and the litter with its burden swung in such
manner that the animals could wind down the steep rocky trail with the
burden between them. In this manner we jogged down the mountainside all
day, our patient laughing and enjoying his pipe as though he were the
guest of honor in some triumphal procession.
While cedar was mentioned as having been used in the above case, the
reader will appreciate that any sort of timber with a tough bark will
answer equally well.
There is one important fact that should always be borne in mind in the
treatment of all fractures, and that is that at least the two adjoining
joints should be fixed. If it is the thigh that is fractured, the hip,
knee, and ankle should be included in the splint. If the leg, then the
knee and ankle. The same rule holds good with fractures of the forearm
or arm.
If timber with tough bark is not available, or in open countries where
no timber grows, a broken bone may be nicely splinted by using small
round sticks. Never use a clapboard unless it is extremely well padded;
even then it is undesirable from the fact that it is liable to press
upon some bony point and cause trouble. Also it is very liable to slip
and permit your fractured bone to become displaced.
To fix a limb by using round sticks, wrap the limb well in soft cloth;
then, having cut your sticks the right length, place them at regular
intervals about the limb and bind as before. In the absence of anything
better, two leather gun scabbards make quite effective splints.
What has been said with regard to fractures of the lower limb will
apply with equal force to breaks of the upper except, of course, that
the case is one of far less gravity. In cases of fracture of the arm,
either above or below the elbow, the injured person can make himself
quite comfortable by pinning the bottom of his coat to his shoulder
and placing the injured arm in the V-shaped sling thus formed.
The treatment of compound fractures is one that requires some "nerve"
on the part of the acting surgeon and a great deal of fortitude in the
injured person. A compound fracture of the leg or thigh is the most
terrible accident, short of death, that can befall a man in the woods.
Unless great care is exercised the man will die, either shortly from
septic poisoning, or almost immediately from shock.
First, get your patient into camp if he is away from it. That may be
done in the following manner, which will also illustrate how to carry a
person injured in any manner: take a blanket and lay it at full length
on the ground; place a pole two feet longer than the blanket directly
in the center and fold the blanket over it; lay a similar pole in the
center of the folded half and fold the free side back over; place your
patient on top, and two men can carry him as comfortably as though he
were in a litter. It is, in fact, an emergency litter.
Another emergency litter may be constructed by buttoning an overcoat
its full length and running two poles down the sides, laying the
patient between them. Failing an overcoat, two short coats or Mackinaw
jackets may be made to serve.
Having got your patient with the compound fracture into camp, cut
off all clothing from the wounded limb, but no more. It is a bad
plan to remove too much clothing from badly injured persons. All the
warmth must be conserved, even to the extent of applying artificial
heat. Examine the wound for foreign matter and carefully remove it,
especially bits of clothing, leaves, small sticks, and bits of earth.
While you have been thus engaged, water should be heated in the
cleanest, brightest vessel the camp affords. If there are none bright
enough, one may be sterilized by burning it over a hot fire for at
least ten minutes. It is absolutely essential that the water used to
cleanse a wound of this character should be sterile—that is, without
any germ life whatever; hence the directions for boiling it.
In another clean vessel boil all the cloths, towels, and other
dressings that you intend using. Any soft cloth will do for dressings,
provided it is sterilized and sterilization consists only in thorough
boiling.
One of the articles I shall mention in a very limited surgical kit is a
bottle of tablets composed of bichloride of mercury known as Bernay's
tablets. They are made by all chemical houses and vary in form, but all
contain about the same quantity of the antiseptic agent. Some are white
and some blue in color, the blue being preferable.
One of these tablets dissolved in a quart of water makes a solution of
about the proper strength for dressing wounds. Make your solution and
with your sterilized cloths wash out the wound thoroughly, and that
does not mean to let a little water flow over the wound; it means to
remove every particle of foreign matter in and about the wound.
If the bones have stuck into the earth, as is quite often the case,
they must be exposed and the narrow canal cleaned. Then replace the
bones in as nearly their proper position as possible. Do not attempt
to "set" the bone; just put it back fairly nearly in line. Then cover
with several layers of moist cloth that have been previously boiled and
dipped in the bichloride solution.
Every day expose the wound, wash it out, and dress it. If the patient
is of strong physique and God smiles, he may not have septic fever. If,
however, the limb shows signs of inflammation evidenced by swelling
and redness, accompanied by fever, chills, and thirst, then must you
perform some heroic tasks to save your patient's life.
Remove all dressings and wrap in perfectly clean dressings the entire
limb from the hip to the foot, elevate so that it will drain properly,
and keep cold water running over it in a small stream constantly. This
may be done by making a small hole in the side or the bottom of a
bucket and hanging it in such a way that it will permit the stream to
fall on the limb. If you follow the foregoing directions implicitly,
you have done all that can be done.
It will be understood that what I have said touches upon the subject of
fractures in only a very general way. The methods of treatment outlined
will apply to practically any fracture, and certainly to those most
liable to be encountered in the woods.
The four principal dislocations that are liable to engage your
attention are those of the hip, knee, elbow, and shoulder. Of these,
that of the hip is the most serious. Without going deeply into the
classification of hip-joint dislocation, it will be sufficient to say
that fortunately by far the greater number of these is where the head
of the bone slips out of its socket upward and backward. Those in which
the head of the bone occupies other positions with relation to its
socket are much more difficult, in fact, for the layman practically
impossible.
The signs of a hip-joint dislocation are shortening of the limb, loss
of motion, pain, and the turning of the toes in toward the opposite
foot. You will be able to distinguish it from a fracture of the thigh
by the absence of crepitation (which I have described as the slight
grating sound made by the broken ends of the bone rubbing together),
and the fact that in a fracture the toes are generally turned out.
A friend of mine once reduced his own hip-joint dislocation in a
manner that may prove instructive. He was coming down the steep side
of a mountain in winter on skees. Halfway down the hill, while he was
traveling at a great rate of speed, he ran into a depression, breaking
his skee and dislocating his hip. It was many miles to the nearest
cabin, night was coming on, and it was bitterly cold. Death stared him
in the face. It was a time for the exercise of judgment if ever in his
life.
He crept down to a grove of small pines, selected two that were just a
little farther apart than the length of his body, lashed the foot of
the injured limb to one with his pack strap, lay at full length on the
snow, and clasped the other with his arms. Pulling with all his might,
he had the satisfaction of hearing the bone jolt back into its socket.
The idea suggested will enable the reader to modify the method to suit
each individual case.
In dislocations of the shoulder the old method still in vogue among
some medical men is quite easy of accomplishment. Lay the patient on
his back and seat yourself at his side, first having removed the shoe
from your foot next to his body. Grasp his injured arm and turn it
outward from the body. Place your bare foot well up into his armpit.
While an assistant steadies his shoulder, pull downward upon his arm,
at the same time moving it toward the patient's body.
Make your pull steady, and when you have begun do not relax until you
feel the bone jolt into its position. In the case of muscular persons
the pull must be kept up for a longer period, or until the contraction
of the muscles has been overcome.
Dislocations of the elbow are usually those in which the two lower
bones slip backward and the upper bone forward. They may be reduced by
grasping the injured arm just above the elbow with your left hand, the
fingers just behind the prominence of the dislocation; with the other
hand bend the injured arm well forward, at the same time slipping your
left hand downward.
When the injured arm is fully bent, grasp tightly with your left hand
at the elbow joint and with your right forcibly straighten it. The
fingers of your left hand form a fulcrum for the bone that is out of
place to act upon and thus force it back into position. This maneuver
is somewhat difficult to describe but quite easy to accomplish. One
will be surprised with what ease the bone slips back into position.
Dislocations of the knee are reduced similarly, except that it requires
two to do the work. Then, too, the knee often becomes dislocated
laterally and the pressure must be made in a lateral direction.
A very distressing little accident is the dislocation of the lower jaw.
I once had a patient who rode a long distance with his mouth wide open,
suffering a great deal of inconvenience and no little pain, when one
of his friends could have relieved him in an instant. Wrap both your
thumbs in several layers of cloth, stand behind the patient, who should
be seated, and place your thumbs thus protected, on his back teeth,
grasp his jaws on either side with your fingers, press down with your
thumbs, up with your fingers, at the same time drawing the jaw forward.
The bones will go back with a snap and the victim will spasmodically
close his mouth hard enough to draw blood unless your thumbs are well
shielded.
Dislocations of the joints of the fingers may be reduced by taking
a double half-hitch around the finger below the dislocation with
a handkerchief, placing your left thumb back of the head of the
dislocated bone, and as you pull on the handkerchief with your right
hand push forward and downward with your left. The bone will readily
slip into place.
Dislocations should be kept at rest for several days and any tendency
toward inflammation kept down by the application of water. Severe
dislocations, as those of the hip, should be treated similarly to
fractures.
Sprains and bruises, while not serious, are often very annoying. When
the accident first occurs immerse the limb in cold spring water.
This has a tendency to contract the small blood vessels and keep
down inflammation. If, however, swelling has already set in, hot
water should give place to cold, as hot as can be borne. A consistent
application of hot water to a sprain or bruise will ordinarily cure it
in a few days.
It may be necessary, under certain conditions, to bandage the limb,
especially if one has to make a journey. By applying a roller
bandage snugly about a sprained ankle, for instance, one may travel
in comparative comfort for several miles. Of course, he will pay
the penalty afterwards, but I am speaking now of cases where it is
imperative that a man travel.
In applying any bandage be sure that it has no wrinkles in it. It must
be laid perfectly smooth and drawn reasonably tight. A loose bandage or
one that is placed unevenly is worse than useless.
CARING FOR BURNS, CUTS,
DROWNING, AND MINOR
ACCIDENTS