CARING FOR BURNS, CUTS, DROWNING, AND MINOR ACCIDENTS
In speaking of fractures and dislocations I did not dream it necessary
to suggest anything in the way of a surgical kit. The element of
instruments other than bandages does not enter largely into the
treatment of this class of injuries, and the bandages may be improvised
from materials at hand.
In the treatment of such wounds as we shall now take up, however, it
will be necessary to carry a few things with which to work. This outfit
will be limited in its scope, economy of space being imperative. A
convenient instrument roll may be made from a strip of canvas, with a
pocket at the bottom and loops for holding instruments. This can be
rolled into compact shape when filled and tied with tape.
In the pocket place a card of assorted silk ligature, ranging in size
from one to six, half a dozen egg-eyed needles ranging from full to
half curve, one yard of oiled silk or an equal amount of gutta-percha
tissue, one bottle bichloride of mercury tablets mentioned before, half
ounce Squibb's surgical powder in shaker-top can, four ounces absorbent
cotton in carton, two yards sterilized cotton gauze sealed, a paper
of safety pins and another of common pins, one soft rubber catheter,
number 9, one roll adhesive tape two inches wide.
In the loops place one needle-holder (Emmet's), one hypodermic
syringe (all metal), one pair straight shears about six inches, two
hemostatic forceps (Kelly's), one curved bistoury (small), and one
splinter forcep. The metal case for the hypodermic has compartments
for small tubes containing the hypodermic tablets. Take one tube each
of the following: hydrochlorate cocaine gr. 1/4, morphine sulphate gr.
1/4, strychnine sulphate gr. 1/60. With the foregoing rather limited
equipment you will be able to render assistance to a person injured in
any of the accidents likely to occur in the woods.
There are a few surgical principles that should be impressed upon your
mind before the subject of treatment is taken up. The first and most
important of these is that it requires a great deal more loss of blood
than is popularly supposed to endanger life. There is no danger from
hemorrhage from a vein and but little from any of the smaller arteries.
The free flow of blood from a wound instead of being alarming is the
most beneficial thing that can happen. The cleansing power of flowing
blood cannot be overestimated and it is cleansing that all wounds
require. That brings up a second thought. All serious consequences
arising from incised or punctured wounds come from the invasion of
bacteria, and all your efforts should be directed against these
energetic little gentlemen, either those that have already entered the
wound or those that are striving to gain ingress.
A simple cut will, if permitted to seal itself up in its own blood,
generally heal without any further interference. The man who puts
tobacco, flour, soap, or any other of the popular monstrosities on a
wound is little short of a criminal.
While, theoretically, many people know that blood flowing in a steady
stream is coming from a vein and that flowing in jets or spurts
is coming from an artery, few know how to take advantage of that
knowledge. The general rule to make pressure between the heart and the
wound in case of a jet and between the wound and the extremity in case
of a stream is only good as a general rule; there are exceptions and
it is exceptions that make the rule dangerous. There are times when it
becomes necessary to reverse the process.
The proper way is to make compression with your fingers until you
have located the region the blood comes from; then apply your steady
compression in that locality. There are a few great arterial trunks
that lie near the surface and may become injured, the injury causing
death from hemorrhage. The manner of locating the compression point for
these arteries will be given.
The first of these is the great artery that runs down the inside of the
leg, called the femoral. Bleeding from this vessel will result in death
in a very few minutes, and it has been known to be severed by a man
falling on his sheath knife. The bleeding may be controlled by grasping
the leg with the fingers near the body. About half way down the inner
surface of the leg the fingers will fall into a slight depression, at
the bottom of which lies the femoral artery.
Any of the vessels of the lower limb may be controlled by compressing
just behind the knee between the two prominent tendons that will be
found there when the leg is doubled up. Arteries of the forearm and
hand can be stopped by pressing with the thumb at the elbow joint just
to the inner side of the tendon of the biceps which you may feel like
a cord when the arm is extended. If the bleeding is from the upper arm
stretch the whole arm by raising it above the head. Feel in the armpit
and you will locate a prominent ridge on the inner side; press with
your fingers just behind that ridge and you will shut off the blood
supply from the whole arm. These are the more prominent vessels that
lie near the skin.
Certain of these larger arteries require ligation. The ligation of
an artery calls for a certain amount of surgical skill, but if it is
necessary to save life you can do it. Surgeons now use sterilized
catgut for the purpose, but silk can be used as well, taking care to
leave sufficient end hanging out of the wound to remove it by.
After having made compression and controlled the hemorrhage, clean out
the wound and loosen your tourniquet until the blood spurts. Locating
the artery, grasp it in the bite of the hemostatic forceps. Cut off a
short piece of silk and tie it loosely around the forceps. Have some
one pull up on the forceps and at the same time with your forefingers
slip the knot down over the end of the cut vessel. Tie tight and remove
your forceps.
This procedure will be necessary only in case of injury to large
vessels. Smaller arteries can be controlled by the means hereafter
described, or by placing a heavy pad of gauze over them and making
compression with a tight bandage. The blood will become entangled in
the meshes of the cloth and form a clot.
Incised wounds inflicted with sharp instruments will be found to
comprise practically all the injuries occurring in the woods. The
method of treating one will illustrate that of dealing with all. Let us
suppose that in cutting firewood the camper has had the misfortune to
drive a sharp ax into his instep (a quite common accident). The blood
spouts at once in a very alarming manner. He hobbles to the camp and
removes his shoes. An ugly gaping wound appears, from the bottom of
which blood is jetting, indicating that an artery has been severed.
The first thing necessary is to stop the blood. Take a handkerchief or
other cloth and tie it about the ankle rather loosely, place a small
stick or a table fork beneath it and twist. In a few turns you will
note that the blood is flowing with less force and shortly will cease
altogether.
When the bleeding has been entirely controlled get out your surgical
kit and throw a pair of the hemostatic forceps into the boiling water.
After they are sterilized wash the wound free from blood with pure
water. I will add in this connection that spring water in the mountains
is practically sterile and can be used for washing wounds without any
danger of infection.
After the wound is clean have some one slightly loosen the tourniquet.
As he does this watch sharply for the jet of blood that will locate the
cut artery. As soon as you see it grasp it with the forceps, lock them,
and leave them in place. The compression of the forceps while you are
getting ready your other instruments will seal up the vessel so that
when you remove them it will not bleed any more.
Take two of your full curved needles, at least two inches long, and
thread them with quite coarse silk, cut off a piece of your gauze
and run the needles through it. Place the needles thus prepared, the
needle holder, shears, and the other pair of hemostats in a vessel and
boil. In the meantime make up a solution of the bichloride, using the
antiseptic tablets for that purpose.
Wash your hands well and rinse them in the bichloride solution. Clean
out the wound, taking great care to remove all clots. With one of the
threaded needles in the grasp of the needle holder begin at the upper
angle of the wound, about half an inch from the end. Pass the needle
down through the flesh one-fourth of an inch from the edge, carrying it
well toward the bottom and making it enter the wound near the bottom
and re-enter the flesh on the opposite side, pass up through and out an
equal distance from the edge. Cut the thread off and lay the two ends
out of your way, leaving, of course, sufficient to tie with when the
time comes.
Place your row of stitches half an inch apart all down the wound. When
all the stitches are in place you may begin to tie. Take the two ends
of the first stitch in your hands and lift up on them; this will bring
the edges of the wound together. Tie the thread, turning the first knot
under twice to prevent its slipping. After all the stitches have been
tied take the handle of your scalpel or the forceps and raise the edges
of the skin, which will have rolled in, until they meet each other.
This is necessary, as where the skin is rolled in it will not heal
readily and leaves an opening for the entrance of bacteria.
Sponge off all the free blood and dust well with surgical powder. Place
a pad of gauze that has been soaked in the bichloride solution over the
wound, cover that with a wad of cotton and the cotton with a piece of
oiled silk, bandage over all, and do not molest for at least three days.
After five days you may remove your stitches in this manner: Cut the
stitch near the skin on one side, grasp the knot in the bite of the
forceps and pull it out. Be careful not to try to pull the knot through
the flesh, and do not leave any end on the part you do pull through
the flesh, as it may carry infection down into the wound.
It is a fact not generally known to the laity that a solution of common
salt and water will take the place of blood when introduced into the
system. Surgeons resort to this practice in performing all very bloody
operations. Their method of hypodermoclysis could not be carried out
in the camp, of course, but a very good substitute for it can be used.
The lower bowel is very receptive of this solution, which by the way,
is made by dissolving a teaspoonful of clean common salt in a pint of
water. The solution, maintained at blood heat, is introduced into the
lower bowel with a fountain syringe. Persons who have lost a great deal
of blood, so much in fact that their pulse can hardly be felt at the
wrist, will receive great benefit from this procedure. Use at least a
gallon of the solution and do not permit it to flow too rapidly into
the bowel.
Certain cuts may be dressed without stitches. Proceed as before up to
the point of putting in the stitches, then roll up two pieces of gauze
as long as the cut and about the size of a lead pencil. Lay these on
either side of the wound quite close to it. With adhesive tape half an
inch wide and four inches long begin two inches on either side of the
wound and carry across, bringing the edges of the wound together. Place
these strips half an inch apart until the wound is brought into line.
Dress as before, except that you will have to omit the moist gauze,
dressing with the powder entirely.
I want to add here that should you run out of sterilized gauze at any
time you can make it from any soft cloth by boiling it for ten minutes
in the bichloride solution and hanging in the air to dry.
The pain attendant upon any surgical manipulation can be prevented by
the hypodermic injection of a solution of cocaine. When you get your
hypodermic have the instrument man show you how it works. He can show
you much better than I can tell it. Insert the needle half an inch
from the wound and inject a few drops of the solution into the skin.
Proceed thus entirely around the wound and by the time you are through
the wound will be perfectly painless. Before replacing the instrument
in its case always dry it out and replace the small brass wire that you
will find in the needle.
It is somewhat difficult to approach the subject of punctured
wounds, which also include those resulting from gun shots and powder
explosions. The rule among surgeons is to meddle with these injuries as
little as possible, provided they do not penetrate the abdomen. In the
case of penetrating wounds caused by falling on a sharp stick or other
sharp pointed instrument, it is well to clean out the wound, removing
all foreign substance that may be present, searching diligently for
pieces of cloth, rust, charcoal, bark, or other foreign matter. These
things in certain localities contain the germ of lock-jaw, and many
contain it anywhere.
This is particularly true of felt wads from shotgun shells. All
diligence should be exercised to clean out a wound resulting from such
a cause. Shotgun wads are manufactured from the most filthy kinds of
old hair, often reeking with the bacillus of tetanus.
If the wound was caused by a sliver of wood and the sliver still
remains in the wound remove it by making an incision with your
bistoury. Do not be afraid to cut. A little cut is worse than none; go
deep enough to liberate the sliver so that it may be removed with the
splinter forceps. Then wash the wound from the bottom with hot water
and dress as before, using the bichloride.
Experience has proved that the less one attempts to do with gunshot
wounds the better. Nature has a tendency to wall off foreign bodies
that are in the main sterile and will ordinarily do so with a bullet if
given a chance. Keep the patient quiet, prevent infection from entering
the wound, and trust to Nature to do the rest.
An incident will illustrate what takes place when Nature is given an
opportunity to throw out her plastic wall material around a foreign
body. Some years ago a party of Eastern people were camping in the
heart of the Bitter Roots. Among the party were two boys of the age
when boys are prone to try experiments. They bored a small hole in a
spruce tree and drove into it a high power 30–30 cartridge. Then they
stood off some fifteen feet and fired at the cartridge with a small
rifle. One of them hit it.
The 30–30 shell came back and penetrated the abdomen of the juvenile
marksman, burying itself and driving pieces of clothing into the
abdominal cavity. The messenger who came for me was thirty-six hours
on the trail and I was an equal length of time reaching the camp.
The people had had sense enough to keep the patient quiet and I found
him resting fairly easy. So deeply had the missile penetrated that it
required a considerable incision to remove it.
When I reached the bottom of the wound I found that Nature had thrown
about the wounded area a wall of protective lymph and all the pus that
had accumulated was in a pocket. I laid the pocket well open, evacuated
its contents, and removed the bits of cloth that I found, dressed the
wound, and had the satisfaction of seeing the youngster recover.
Burns are classified according to degree of injury. Those of the first
degree are where the skin is reddened, but no blister formed. The
second degree includes those where there has been decided blistering,
and the third, where the flesh has been charred. Those of the first and
second degrees are the most common in about the proportion of 99 to 1.
A burn of the first degree can be best relieved by the application of
cold water. This is contrary to the teachings of a few years ago, but
is in full accord with that of to-day. The water should be changed as
fast as it becomes warm.
Burns of the second degree require more care. In the first place, do
not interfere with the blister. The primary object in treating burns is
to exclude air and the skin remaining intact will do this much better
than any artificial means.
The Indians of the Northwest prepare a dressing for burns by cooking
deer suet with balm of gilead buds. This is the most effective
application for severe burns I have ever seen. If deer suet is not
available, any fresh tallow that has been cooked will serve as well.
Throw a handful of the buds into a vessel and cover them with the suet,
boil for thirty minutes, and strain. When nearly cold apply to the burn
and cover with a soft cloth. The pain ceases almost immediately.
It seems singular after all that has been written on the subject, but
few people know how to restore a drowned person. The matter is really
quite simple, yet it requires great attention to detail. Spasmodic
efforts are useless. The thing has to be gone about methodically and
the method persisted in for a long time, often in the face of seeming
certain defeat.
In the first place, statistics show that no person who has been
submerged in the water for a period of seven minutes was ever
resuscitated. It is extremely doubtful if after five minutes' immersion
anything can be accomplished, still it is worth the effort.
The first thing to do when a person is rescued from the water is to
remove all clothing from about the chest and neck. Do not take the time
to draw the garments off, but rip them off with a knife. Turn the body
over and stand astride it. Grasp it about the middle and lift up so
that only the head and feet are touching the ground. This is done in
order to free the lungs and air passages from water and mucus. Do this
several times.
With a handkerchief wipe out the mouth and as far down the throat as
you can reach. Lay the patient on his back with a folded coat under his
shoulders. Kneel at his head and grasp both arms at the wrists and pull
them well up over his head, hold for an instant, return to the sides
and press them against the ribs, hold for an instant and repeat. Do
this about twenty times each minute.
The tendency is to work too fast. The movement should be about as
fast as a man breathes, the object being to simulate the ordinary
respiratory movements as nearly as may be. While this is being done
another person may grasp the tongue and pull it up and out of the
mouth, keeping time with the movements of the arms. When the patient
begins to show signs of life wrap him well in hot blankets, place hot
stones at his feet, and administer hot water, brandy, or strong hot
coffee.
As before suggested, the efforts at restoration should be persisted in
for a long time, until either success rewards your efforts or the body
becomes quite cold and rigid. It may be that there is a little spark of
life left and you may fan it into flame after hours of effort.
There are many minor accidents for which it is well to be prepared. For
example, to remove a fish hook: Do not try to pull it back; push it on
through, file or break off the barb and it can be removed readily.
To remove foreign bodies from the eye: First cocainize the eye by
dropping a few drops of a solution made by dissolving one of the
cocaine tablets in a half teaspoonful of water, then turn the lid back
over a match telling the person to look down at the same time, and
brush the substance off with a soft cloth. If it is under the lower lid
place your forefinger on his cheek just beneath the eye, pull down, and
tell him to look up. If it adheres to the eyeball, as in the case of a
cinder or a small piece of steel, after cocainizing the eye remove with
a sharp knife by brushing.
Insects sometimes crawl into the ear and make a lot of commotion. Place
the patient on his side with that ear uppermost and pour plenty of warm
water into the ear. By plenty I mean several quarts. The bug will crawl
out or be washed out by the returning stream of water.
Burns well characterized toothache as "Thou hell of a' diseases." If
the tooth has a cavity (as it probably has), a small crystal of cocaine
dropped dry into the cavity and covered with a little pledget of cotton
will give immediate relief.
For bleeding from the nose, place a pledget of cotton in each nostril,
lay the patient on his face, and pour cold water over the back of the
neck. Leave the cotton there for several hours. The idea is that the
fibrin in the blood becomes entangled in the fiber of the cotton and
sets up a clot that seals the bleeding surface, while the cold water
closes the blood supply by its action on the artery supplying the parts.
Hiccough is a distressing and sometimes a dangerous complaint. Many
times a swallow of water will stop it. If simple measures fail, the
following has been found very efficacious. The nerves that produce
hiccough are near the surface in the neck. They may be reached and
compressed by placing two fingers right in the center of the top of the
breastbone between the two cords that run up either side of the neck
and pressing inward, downward, and outward. A few minutes' pressure of
this kind will stop the most obstinate hiccough.
Certain injuries are attended with what is known as shock. Usually
the degree of shock is proportionate to the extent of the injury,
though not always so. Often seemingly trivial injuries produce a fatal
shock. The symptoms are cold, clammy skin, face very pale and pinched,
eyes widely dilated and staring, pulse rapid and irregular, little or
no pain, even from severe injuries. The patient retains his mental
faculties but loses the power to originate, answering when spoken to
but usually volunteering no statements of his own.
The treatment consists in lowering the head and elevating the
extremities. Wrap the patient in hot blankets and place hot water
bottles about him, give brandy, or what is as good, hot water; inject
1/30 gr. strychnia every fifteen minutes for three doses.
The symptoms from loss of blood are very much the same as from shock
and luckily respond to the same treatment. In addition, if there
chances to be a fountain syringe in the camp, give rectal enemas of hot
normal salt solution, which can be made by dissolving a teaspoonful
of common salt in a quart of sterile water. In some way this solution
seems to take the place of the blood lost. A hot application over the
heart is also valuable, as are mustard drafts to the spine.
MEDICAL TREATMENT OF CAMP
DISEASES