=Wounds, Sprains and Bruises=
_Treatment of Wounds--Rules for Checking Hemorrhage--Lockjaw--Bandages
for Sprains--Synovitis--Bunions and Felons--Foreign Bodies in the Eye,
Ear and Nose._
=WOUNDS.=--A wound is a condition produced by a forcible cutting,
contusing, or tearing of the tissues of the body, and includes, in its
larger sense, bruises, sprains, dislocations, and breaks or fractures
of bones. As ordinarily used, a wound is an injury produced by
forcible separation of the skin or mucous membrane, with more or less
injury to the underlying parts.
_The main object during the care of wounds should be to avoid
contamination with anything which is not surgically clean, from the
beginning to the end of the dressing; otherwise, every other step in
the whole process is rendered useless._
Three essentials in the treatment of wounds are:
1. The arrest of bleeding. 2. Absolute cleanliness. 3. Rest of the
injured part. Dangerous bleeding demands immediate relief.
Bleeding is of three kinds: 1. From a large artery. 2. From a vein. 3.
General oozing.
=BLEEDING FROM LARGE ARTERY IN SPURTS OF BRIGHT BLOOD.=
_First Aid Rule 1.--Speed increases safety. Put patient down flat.
Make pressure with hands between the wound and the heart till surgeon
arrives, assistants taking turns._
_Rule 2.--If arm or leg, tie rubber tubing or rubber suspenders tight
about limb between wound and heart, or tie strap or rope over
handkerchief or folded shirt wrapped about limb. If arm, put baseball
in arm pit, and press arm against this. Or, for arm or leg, tie folded
cloth in loose noose around limb, put cane or umbrella through noose
and twist up the slack very tight, so as to compress the main artery
with knot._
_Rule 3.--Keep limb and patient warm with hot-water bottles till
surgeon arrives._
This treatment is of course only a temporary expedient, as it is
essential for a surgeon to tie the bleeding vessel itself; therefore a
medical man should be summoned with all dispatch.
=BLEEDING FROM VEIN; STEADY FLOW OF DARK BLOOD.=
_First Aid Rule 1.--Make firm pressure with pad of cloth directly over
wound, also with hands between wound and extremity, that is, on side
of cut away from the heart._
_Rule 2.--Tie tight bandage about limb at this point, with rubber
tubing or suspenders._
_Rule 3.--Keep limb and patient warm with hot-water bottles till
surgeon arrives._
In the cases of bleeding from a vein, the flow of blood is continuous,
and is of a dark, red hue, and does not spurt in jets, as from an
artery. This kind of bleeding is not usually difficult to stop, and it
is not necessary that the vein itself be tied--unless very
large--provided that the wound be snugly bandaged after it is dressed.
After the first half hour, release the limb and see if the bleeding
has stopped. If so, and the circulation is being interfered with,
owing to the tightness of the bandage, reapply the bandage more
loosely.
In the case of an injured artery of any considerable size, the amount
of pressure required to stop the bleeding will arrest all circulation
of blood in the limb, so that great damage, as well as pain, will
ensue if it be continued more than an hour or two, and during this
time the limb should be kept warm by thick covering and hot-water
bags, if they can be obtained.
Bleeding _from a deep puncture_ may be stopped by plugging the cavity
with strips of muslin which have been boiled, or with absorbent
cotton, similarly treated, keeping the plug in place by snug
bandaging.
=BLEEDING FROM PUNCTURED WOUND.=
_First Aid Rule 1.--Extract pin, tack, nail, splinter, thorn, or
bullet, IF YOU CAN SEE BULLET; do not probe._
_Rule 2.--Pour warm water on wound and squeeze tissue to encourage
bleeding. Send for small hard-rubber syringe._
_Rule 3.--If deep, plug it with absorbent cotton, and put tight
bandage over plug. If shallow, cover with absorbent cotton wet with
boric-acid solution (one dram to one-half pint of water), or
carbolic-acid solution (one teaspoonful to the pint of hot water)._
_Rule 4.--When syringe comes, remove dressing, and clean wound by
forcibly syringing carbolic solution directly into wound. Replace
dressing._
A small punctured wound should be squeezed in warm water to encourage
bleeding and, if pain and swelling ensue, absorbent cotton soaked in a
boric-acid solution (containing as much boric acid as the water will
dissolve) or in carbolic-acid solution (one teaspoonful of pure acid
to the pint of warm water) should be applied over the wound and
covered with oil silk or rubber or enamel cloth for a few days, or
until the soreness has subsided. The dressing should be wet with the
solution as often as it becomes dry. Punctures by nails, especially if
deep, should be washed out with a syringe, using one of the solutions
just mentioned. A medicine dropper, minus the rubber part, attached to
a fountain syringe, makes a good nozzle for this purpose. A moist
dressing, like the one described, should then be applied, and the limb
kept in perfect rest for a few days.
When a surgeon's services are available, however, self-treatment is
attended with too much danger, as a thorough opening up of such wounds
with proper cleansing and drainage will afford a better prospect of
early recovery, and avert the risk of serious inflammation and
lockjaw, which sometimes follow punctured wounds of the hands and
feet. Foreign bodies, as splinters, may be removed with tweezers or a
needle, being careful not to break the splinter in the attempt. If a
part remains in the flesh, or if the foreign body is a needle that
cannot be found or removed at once, the continuous application of a
hot flaxseed or other poultice will lead to the formation of "matter,"
with which the splinter or needle will often escape after a few days.
Splinters finding their way under the nail may be removed by scraping
the nail very thin over the splinter and splitting it with a sharp
knife down to the point where the end of the splinter can be grasped.
=BLEEDING IN FORM OF OOZING.=
_First Aid Rule 1.--Apply water as hot as hand can bear._
_Rule 2.--Elevate the part, and drench with carbolic solution (one
teaspoonful of carbolic acid to one pint of hot water)._
_Rule 3.--Bandage snugly while wet._
_Rule 4.--Keep patient warm with hot-water bottles._
=GENERAL OOZING= happens in the case of small wounds or from abraded
surfaces, and is caused by the breaking of numerous minute vessels
which are not large enough to require the treatment recommended for
large arteries or veins. It is rarely dangerous, and usually stops
spontaneously. When the loss of blood has been considerable, so that
the patient is pale, faint, and generally relaxed, with cold skin, and
perhaps nausea and vomiting, he should be stripped of all clothing and
immediately wrapped in a blanket wrung out of hot water, and then
covered with dry blankets. Heat should also be applied to the feet by
means of hot-water bags or bottles, with great care not to burn a
semiconscious patient's skin. The head should be kept low, and two
tablespoonfuls of brandy, whisky, or other alcoholic liquor should be
given in a half cup of hot water by the mouth, if the patient can
swallow. If much blood has been lost a quart of water, as hot as the
hand can readily bear, and containing a teaspoonful of common salt,
should be injected by means of a fountain syringe into the rectum.
Somewhat the condition just described as due to loss of blood may be
caused simply by shock to the nervous system following any severe
accident, and not attended by bleeding. The treatment of shock is,
however, practically the same as that for hemorrhage, and improvement
in either case is shown by return of color to the face and strength in
the pulse. Bleeding is apt to be much less in badly torn than in
incised wounds, even if large vessels are severed, as when the legs
are cut off in railroad accidents, for the lacerated ends of the
vessels become entangled with blood and favor clotting.
=LOCKJAW.=--In the lesser injuries, where bleeding is not an important
feature, and in all wounds as well, after bleeding has been stopped,
the main object in treatment consists in cleansing wounds of the germs
which cause "matter" or pus, general blood poisoning, and lockjaw. The
germs of the latter live in the earth, and even the smallest wounds
which heal perfectly may later give rise to lockjaw if dirt has not
been entirely removed from the wound at the time of accident. Injuries
to the hands caused by pistols, firecrackers, and kindred explosives,
seem especially prone to produce lockjaw, and fatalities from this
disorder are deplorably numerous after Fourth-of-July celebrations in
the United States.
The wounds producing lockjaw usually occur in children who explode
blank cartridges in the palm of the hand. In this way the germs of the
disease are forced in with parts of the dirty skin and more or less of
the wad from the shell. Since lockjaw is so frequent after these
accidents, and so fatal, it is impossible to exert too much care in
treatment. The wound should at once be thoroughly opened with a knife
to the very bottom, under ether, by a surgeon, and not only every
particle of foreign matter removed, but all the surrounding tissue
should be cut out or cauterized. In addition, it is wise to use an
injection under the skin of tetanus-antitoxin, to prevent the disease.
Proper restriction of the sale of explosives alone will put a stop to
this barbarous mode of exhibiting patriotism.
=Treatment.=--It is not essential to use chemical agents or
antiseptics to rid wounds of germs and so secure uninterrupted
healing. The person who is to dress the wound should prepare to do so
at the earliest possible moment after giving first aid. He should
proceed promptly to boil some pieces of absorbent cotton, as large as
an egg, together with a nail brush in water. Some strips of clean
cotton cloth may be used in the absence of absorbent cotton. The
boiling should be conducted for five minutes, when the basin or other
utensil in which the brush and cotton are boiled should be taken off
the fire and set aside to cool. Then the attendant should scrub his
own hands for five minutes in hot water with soap and brush.
He next takes the brush, which has been boiled, out of the water and
cleans the patient's skin for a considerable distance about the wound.
When this is done, and the water and cotton which have been boiled are
sufficiently cool, the wound should be bathed with the cotton and
boiled water until all foreign matter has been removed from the wound;
not only dirt which can be seen, but germs which cannot be seen. Some
of the boiled cotton cloth or absorbent cotton, wet as it is, should
be placed over the wound and the whole covered by a bandage. Large
gaping wounds are of course more properly closed by stitches, but very
deep wounds should be left partly open, so that the discharge may
drain away freely. Small, deep, punctured wounds are not to be closed
at all, but should be sedulously kept open by pushing in strips of
boiled cotton cloth, in order to secure drainage.
If the attendant has the requisite confidence, there is no reason why
he should not attempt stitching a wound, providing the patient is
willing, and a surgeon cannot be obtained within twenty-four hours. In
this case a rather stout, common sewing needle or needles are threaded
with black or white thread, preferably of silk, and, together with a
pair of scissors and a clean towel, are boiled in the same utensil
with the cotton and the nail brush. After the operator has scrubbed
his hands and cleansed the wound, he places the boiled towel about the
wound so that the thread will fall on it during his manipulations and
not on the skin. The needle should be thrust into and through the
skin, but no lower than this, and should enter and leave the skin
about a quarter of an inch from either edge of the wound. The stitches
are placed about one-half inch apart, and are drawn together and tied
tightly enough to join the two edges of the wound. The ends of the
thread should be cut about one-half inch from the knot, being careful
while using the needle and scissors not to lay them down on anything
except the boiled towel. The wound is then covered with cotton, which
has been boiled as described above, bandaged and left undisturbed for
a week, if causing no pain. At the end of this time the stitches are
taken out after the attendant has washed his hands carefully, and
boiled his scissors as before.
Court plaster or plaster of any kind is a bad covering or dressing for
wounds, as it may be itself contaminated with germs. It effectually
keeps in any with which the wound is already infected, and prevents
proper drainage.
It is impossible in a work of this kind to describe the details of the
after treatment of wounds, as this can only be properly undertaken by
a surgeon, owing to the varying conditions which may arise. In general
it may be stated that the same cleanliness and care should be followed
during the whole course of healing as has been outlined for the first
attempt at treatment.
If the wound is small, and there is no discharge from it, it may be
painted with collodion or covered with boric-acid ointment (sixty
grains of boric acid to the ounce of vaseline) after the first day. If
large, it should be covered with cotton gauze or cloth which have been
boiled or specially prepared for surgical purposes. If pus ("matter")
forms, the wound must be cleansed daily of discharge (more than once
if it is copious) with boiled water, or best with hydrogen dioxide
solution followed by a washing with a solution of carbolic acid (one
teaspoonful to the pint of hot water), or with a solution of mercury
bichloride, dissolving one of the larger bichloride tablets, sold for
surgical uses, in a quart of water.
It is a surgical maxim never to be neglected that wounds should not be
allowed to close at the top before healing is completed at the bottom.
As to close at the surface is the usual tendency in wounds that heal
slowly and discharge pus, it is necessary at times to enlarge the
external opening by cutting or stretching with the blades of a pair of
scissors, or, and this is much more rational and comfortable for the
patient, by daily packing the outlet of the wound with gauze to keep
it open.
=BLEEDING FROM SCALP.=
_First Aid Rule 1.--Cut hair off about wound, and clean thoroughly
with carbolic-acid solution (one teaspoonful to pint of hot water)._
_Rule 2.--Put pad of gauze or muslin directly over wet wound, and make
pressure firmly with bandage._
In case of wounds of the scalp, or other hairy parts, the hair should
be cut, or better shaved, over an area very much larger than the
wounded surface, after which the cleansing should be done. To stop
bleeding of the scalp, water is applied as hot as can be borne, and
then a wad of boiled cotton should be placed in the wound and
bandaged down tightly into it for a time. Closing the wound with
stitches will stop the bleeding much more effectively, however, and is
not very painful if done immediately after the accident. The stitches
should be tied loosely, and not introduced nearer to each other than
half an inch, to allow drainage of discharge from the wound.
=General Remarks.=--All wounds should be kept at rest after they are
dressed. This is accomplished in the case of the lower limbs by
keeping the patient in bed with the leg raised on a pillow.
The same kind of treatment applies in severe injuries of the hands. In
less serious cases a sling may be employed, and the patient may walk
about. When the injury is near a joint, as of the fingers, knee,
wrist, or elbow, a splint made of thin board or tin (and covered with
cotton wadding and bandaged) should be applied by means of surgeon's
adhesive plaster and bandage after the wound has been dressed. In
injuries of the hand the splint should be applied to the palm side,
and reach from the finger tips to above the wrist. Use a splint also.
=NOSEBLEED.=
_First Aid Rule 1.--Seat patient erect and apply ice to nape of neck._
_Rule 2.--Put roll of brown paper under upper lip, and press lip
firmly against it. Press facial artery against lower jaw of bleeding
side, till bleeding stops. This artery crosses lower edge of jawbone
one inch in front of angle of jaw._
_Rule 3.--Plug nostril with strip of thin cotton or muslin cloth._
_Rule 4.--Do not wash away clots; encourage clotting to close
nostril._
=BLEEDING FROM LUNGS; BRIGHT BLOOD COUGHED UP.=
=BLEEDING FROM STOMACH; DARK BLOOD VOMITED.=
_First Aid Rule for both. Let patient lie flat and swallow small
pieces of ice, and also take one-quarter teaspoonful of table salt in
half a glass of cold water._
=BRUISE.=
_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 scraped 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, passed around the whole circumference 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 assistant
very gently the first day, with gradual increase in vigor as the days
pass, 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 assistant. 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.
[Illustration: 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 illustration, 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 prick or abrasion which may pass 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.
=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.)
[Illustration: 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 buttons, pebbles,
beans, cherry stones, coffee, etc., are frequently placed in the ear
by children, and insects sometimes find their way into the ear passage
and create tremendous distress by their struggles. Smooth,
nonirritating bodies, as buttons, 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 buttons, 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 unobstructed 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."