Part 269 (1/2)
When sufficient blood has been taken away, remove the bandage from above the elbow, and place the thumb of the left hand firmly over the cut, until all the bleeding ceases. A small pad of lint is then to be put over the cut, with a larger pad over it, and the two kept in their places by means of a handkerchief or linen roller bound pretty tightly over them and round the arm.
2606. When a person is bled, he should always be in the standing, or at any rate in the sitting, position; for if, as is often the case, he should happen to faint, he can, in, most eases at least, easily be brought to again by the operator placing him flat on his back, and stopping the bleeding. _This is of the greatest importance._ It has been recommended, for what supposed advantages we don't know, to bleed people when they are lying down. Should a person, under these circ.u.mstances, faint, what could be done to bring him to again? The great treatment of lowering the body of the patient to the flat position cannot be followed here. It is in that position already, and cannot be placed lower than it at present is--except, as is most likely to be the case, under the ground.
2607. BLEEDING FROM THE NOSE.--Many children, especially those of a sanguineous temperament, are subject to sudden discharges of blood from some part of the body; and as all such fluxes are in general the result of an effort of nature to relieve the system from some overload or pressure, such discharges, unless in excess, and when likely to produce debility, should not be rashly or too abruptly checked. In general, these discharges are confined to the summer or spring months of the year, and follow pains in the head, a sense of drowsiness, languor, or oppression; and, as such symptoms are relieved by the loss of blood, the hemorrhage should, to a certain extent, be encouraged. When, however, the bleeding is excessive, or returns too frequently, it becomes necessary to apply means to subdue or mitigate the amount. For this purpose the sudden and unexpected application of cold is itself sufficient, in most cases, to arrest the most active hemorrhage. A wet towel laid suddenly on the back, between the shoulders, and placing the child in a rec.u.mbent posture, is often sufficient to effect the object; where, however, the effusion resists such simple means, napkins wrung out of cold water must be laid across the forehead and nose, the hands dipped in cold water, and a bottle of hot water applied to the feet. If, in spite of these means, the bleeding continues, a little fine wool or a few folds of lint, tied together by a piece of thread, must be pushed up the nostril from which the blood flows, to act as a plug and pressure on the bleeding vessel. When the discharge has entirely ceased, the plug is to be pulled out by means of the thread. To prevent a repet.i.tion of the hemorrhage, the body should be sponged every morning with cold water, and the child put under a course of steel wine, have open-air exercise, and, if possible, salt-water bathing. For children, a key suddenly dropped down the back between the skin and clothes, will often immediately arrest a copious bleeding.
2608. SPITTING OF BLOOD, or hemorrhage from the lungs, is generally known from blood from the stomach by its being of a brighter colour, and in less quant.i.ties than that, which is always grumous and mixed with the half-digested food. In either case, rest should be immediately enjoined, total abstinence from stimulants, and a low, poor diet, accompanied with the horizontal position, and bottles of boiling water to the feet. At the same time the patient should suck through a quill, every hour, half a wine-gla.s.s of water in which 10 or 15 drops of the elixir of vitriol has been mixed, and, till further advice has been procured, keep a towel wrung out of cold water on the chest or stomach, according to the seat of the hemorrhage.
Bites and Stings.
2609. BITES AND STINGS may be divided into three kinds:--1. Those of Insects. 2. Those of Snakes. 3. Those of Dogs and other Animals.
2610. 1. _The Bites or Stings of Insects_, such as gnats, bees, wasps, &c., need cause very little alarm, and are, generally speaking, easily cured. They are very serious, however, when they take place on some delicate part of the body, such as near the eye, or in the throat. _The treatment_ is very simple in most cases; and consists in taking out the sting, if it is left behind, with a needle, and applying to the part a liniment made of finely-sc.r.a.ped chalk and olive-oil, mixed together to about the thickness of cream.
2611. Bathing the part bitten with warm turpentine or warm vinegar is also of great use. If the person feels faint, he should lie quietly on his back, and take a little brandy-and-water, or sal-volatile and water.
When the inside of the throat is the part stung, there is great danger of violent inflammation taking place. In this case, from eight to twelve leeches should be immediately put to the outside of the throat, and when they drop off, the part to which they had been applied should be well fomented with warm water. The inside of the throat is to be constantly gargled with salt and water. Bits of ice are to be sucked. Rubbing the face and hands well over with plain olive-oil, before going to bed, will often keep gnats and musquitoes from biting during the night. Strong scent, such as eau-de-Cologne, will have the same effect.
2612. 2. _Bites of Snakes_.--These are much more dangerous than the preceding, and require more powerful remedies. The bites of the different kinds of snakes do not all act alike, but affect people in different ways.--_Treatment of the part bitten_. The great thing is to prevent the poison getting into the blood; and, if possible, to remove the whole of it at once from the body. A pocket-handkerchief, a piece of tape or cord, or, in fact, of anything that is at hand, should be tied tightly round the part of the body bitten; if it be the leg or arm, immediately _above_ the bite, and between it and the heart. The bite should then be sucked several times by any one who is near. There is no danger in this, provided the person who does it has not got the skin taken off any part of his mouth. What has been sucked into the mouth should be immediately spit out again. But if those who are near have sufficient nerve for the operation, and a suitable instrument, they should cut out the central part bitten, and then bathe the wound for some time with warm water, to make it bleed freely. The wound should afterwards be rubbed with a stick of lunar caustic, or, what is better, a solution of this--60 grains of lunar caustic dissolved in an ounce of water--should be dropped into it. The band should be kept on the part during the whole of the time that these means are being adopted. The wound should afterwards be covered with lint dipped in cold water. The best plan, however, to be adopted, if it can be managed, is the following:--take a common wine-gla.s.s, and, holding it upside down, put a lighted candle or a spirit-lamp into it for a minute or two. This will take out the air. Then clap the gla.s.s suddenly over the bitten part, and it will become attached, and hold on to the flesh. The gla.s.s being nearly empty, the blood containing the poison will, in consequence, flow into it from the wound of its own accord. This process should be repeated three or four times, and the wound sucked, or washed with warm water, before each application of the gla.s.s. As a matter of course, when the gla.s.s is removed, all the blood should be washed out of it before it is applied again.--_Const.i.tutional Treatment_. There is mostly at first great depression of strength in these cases, and it is therefore requisite to give some stimulant; a gla.s.s of hot brandy-and-water, or twenty drops of sal-volatile, is the best that can be given. When the strength has returned, and if the patient has not already been sick, a little mustard in hot water should be given, to make him so. If, on the other hand, as is often the case, the vomiting is excessive, a large mustard poultice should be placed over the stomach, and a grain of solid opium swallowed in the form of a pill, for the purpose of stopping it.
Only one of these pills should be given by a non-professional person. In all cases of bites from snakes, send for a surgeon as quickly as possible, and act according to the above directions until he arrives. If he is within any reasonable distance, content yourself by putting on the band, sucking the wound, applying the gla.s.s, and, if necessary, giving a little brandy-and-water.
2613. 3. _Bites of Dogs_.--For obvious reasons, these kinds of bites are more frequently met with than those of snakes. _The treatment_ is the same as that for snake-bites, more especially that of the bitten part.
The majority of writers on the subject are in favour of keeping the wound open as long as possible. This may be done by putting a few beans on it, and then by applying a large linseed-meal poultice over them.
Injuries and Accidents to Bones.
2614. _Dislocation of Bones_.--When the end of a bone is pushed out of its natural position, it is said to be dislocated. This may be caused by violence, disease, or natural weakness of the parts about a joint.--_Symptoms_. Deformity about the joint, with unnatural prominence at one part, and depression at another. The limb may be shorter or longer than usual, and is stiff and unable to be moved, differing in these last two respects from a broken limb, which is mostly shorter, never longer, than usual, and which is always more movable.--_Treatment_.
So much practical science and tact are requisite in order to bring a dislocated bone into its proper position again, that we strongly advise the reader never to interfere in these cases; unless, indeed, it is altogether impossible to obtain the services of a surgeon. But because any one of us may very possibly be placed in that emergency, we give a few rough rules for the reader's guidance. In the first place make the joint, from which the bone has been displaced, perfectly steady, either by fixing it to some firm object or else by holding it with the hands; then pull the dislocated bone in a direction towards the place from which it has been thrust, so that, if it moves at all from its unnatural position, it may have the best chance of returning to its proper place.
Do not, however, pull or press against the parts too violently, as you may, perhaps, by doing so, rupture blood-vessels, and produce most serious consequences. When you _do_ attempt to reduce a dislocated bone, do it as quickly as possible after the accident has taken place, every hour making the operation more difficult. When the patient is very strong, he may be put into a warm bath until he feels faint, or have sixty drops of antimonial wine given him every ten minutes until he feels sickish. These two means are of great use in relaxing the muscles.
If the bone has been brought back again to its proper place, keep it there by means of bandages; and if there is much pain about the joint, apply a cold lotion to it, and keep it perfectly at rest. The lotion should be, a dessert-spoonful of Goulard's extract, and two tablespoonfuls of vinegar, mixed in a pint of water. Leeches are sometimes necessary.
Unless the local pain, or general feverish symptoms, are great, the patient's diet should be the same as usual. Dislocations may be reduced a week, or even a fortnight, after they have taken place. As, therefore, although the sooner a bone is reduced the better, there is no very great emergency, and as the most serious consequences may follow improper or too violent treatment, it is always better for people in these cases to do too little than too much; inasmuch as the good which has not yet may still be done, whereas the evil that _has_ been done cannot so easily be undone.
2615. FRACTURES OF BONES.--_Symptoms_. 1. Deformity of the part. 2.
Unnatural looseness. 3. A grating sound when the two ends of the broken bone are rubbed together. 4. Loss of natural motion and power. In some cases there is also shortening of the limb.--Fracture takes place from several causes, as a fall, a blow, a squeeze, and sometimes from the violent action of muscles.--_Treatment_. In cases where a surgeon cannot be procured immediately after the accident, the following general rules are offered for the reader's guidance:--The broken limb should be placed and kept as nearly as possible in its natural position. This is to be done by first pulling the two portions of the bone in opposite directions, until the limb becomes as long as the opposite one, and then by applying a splint, and binding it to the part by means of a roller.
When there is no deformity, the pulling is of course unnecessary. If there is much swelling about the broken part, a cold lotion is to be applied. This lotion (_which we will call Lotion No. 1_) may be thus made:--Mix a dessert-spoonful of Goulard's extract and two tablespoonfuls of vinegar in a pint of water. When the leg or arm is broken, always, if possible, get it to the same length and form as the opposite limb. The broken part should be kept perfectly quiet. When a broken limb is deformed, and a particular muscle is on the stretch, place the limb in such a position as will relax it. This will in most cases cure the deformity. Brandy-and-water, or sal-volatile and water, are to be given when the patient is faint. Surgical aid should, of course, be procured as soon as possible.
2616. JOINTS, INJURIES TO.--All kinds of injuries to joints, of whatever description, require particular attention, in consequence of the violent inflammations which are so liable to take place in these parts of the body, and which do so much mischief in a little time. The joint injured should always be kept perfectly at rest; and when it is very painful, and the skin about it red, swollen, hot, and s.h.i.+ning, at the same time that the patient has general feverish symptoms, such as great thirst and headache--leeches, and when they drop off, warm poppy fomentations, are to be applied; the No. 1 pills above-mentioned are to be given (two are a dose for a grown person) with a black draught three hours afterwards.
Give also two tablespoonfuls of the fever-mixture every four hours, and keep the patient on low diet. When the injury and swelling are not very great, warm applications, with rest, low diet, and a dose of aperient medicine, will be sufficient. When a joint has received a penetrating wound, it will require the most powerful treatment, and can only be properly attended to by a surgeon. The patient's friends will have to use their own judgment to a great extent in these and in many other cases, as to when leeches, fever-mixture, &c., are necessary. A universal rule, however, without a single exception, _is always to rest a joint well_ after it has been injured in any way whatever, to purge the patient, and to keep him on low diet, without beer, unless he has been a very great drinker indeed, in which case he may still be allowed to take a little; for if the stimulant that a person has been accustomed to in excess be all taken away at once, he is very likely to have an attack of delirium tremens. The quant.i.ty given should not, however, be much--say a pint, or, at the most, a pint and a half a day. Rubbing the joint with opodeldoc, or the application of a blister to it, is of great service in taking away the thickenings, which often remain after all heat, pain, and redness have left an injured joint. Great care should be observed in not using a joint too quickly after it has been injured.
When the shoulder-joint is the one injured, the arm should be bound tightly to the body by means of a linen or flannel roller, and the elbow raised; when the elbow, it should be kept raised in the straight position, on a pillow; when the wrist, it should be raised on the chest, and suspended in a sling; when the knee, it should be kept in the straight position; and, lastly, when the ankle, it should be a little raised on a pillow.
2617. BRUISES, LACERATIONS, AND CUTS.--Wherever the bruise may be, or however swollen or discoloured the skin may become, two or three applications of the _extract of lead_, kept to the part by means of lint, will, in an hour or little more, remove all pain, swelling, and tenderness. Simple or clean cuts only require the edges of the wound to be placed in their exact situation, drawn close together, and secured there by one or two slips of adhesive plaster. When the wound, however, is jagged, or the flesh or cuticle lacerated, the parts are to be laid as smooth and regular as possible, and a piece of lint, wetted in the _extract of lead_, laid upon the wound, and a piece of greased lint placed above it to prevent the dressing sticking; the whole covered over to protect from injury, and the part dressed in the same manner once a day till the cure is effected.
2618. BRUISES AND THEIR TREATMENT.--The best application for a bruise, be it large or small, is moist warmth; therefore, a warm bread-and-water poultice in hot moist flannels should be put on, as they supple the skin. If the bruise be very severe, and in the neighbourhood of a joint, it will be well to apply ten or a dozen leeches over the whole bruised part, and afterwards a poultice. But leeches should not be put on young children. If the bruised part be the knee or the ankle, walking should not be attempted till it can be performed without pain. Inattention to this point often lays the foundation for serious mischief in these joints, especially in the case of scrofulous persons. In all conditions of bruises occurring in children, whether swellings or abrasions, no remedy is so quick or certain of effecting a cure as the pure extract of lead applied to the part.
Burns and Scalds.
2619. BURNS AND SCALDS being essentially the same in all particulars, and differing only in the manner of their production, may be spoken of together. As a general rule, scalds are less severe than burns, because the heat of water, by which scalds are mostly produced, is not, even when it is boiling, so intense as that of flame; oil, however, and other liquids, whose boiling-point is high, produce scalds of a very severe nature. Burns and scalds have been divided into three cla.s.ses. The first cla.s.s comprises those where the burn is altogether superficial, and merely reddens the skin; the second, where the injury is greater, and we get little bladders containing a fluid (called serum) dotted over the affected part; in the third cla.s.s we get, in the case of burns, a charring, and in that of scalds, a softening or pulpiness, perhaps a complete and immediate separation of the part. This may occur at once, or in the course of a little time. The pain from the second kind of burns is much more severe than that in the other two, although the danger, as a general rule, is less than it is in the third cla.s.s. These injuries are much more dangerous when they take place on the trunk than when they happen on the arms or legs. The danger arises more from the extent of surface that is burnt than from the depth to which the burn goes. This rule, of course, has certain exceptions; because a small burn on the chest or belly penetrating deeply is more dangerous than a more extensive but superficial one on the arm or leg. When a person's clothes are in flames, the best way of extinguis.h.i.+ng them is to wind a rug, or some thick material, tightly round the whole of the body.
2620. _Treatment of the First Cla.s.s of Burns and Scalds_.--_Of the part affected_.--Cover it immediately with a good coating of common flour, or cotton-wool with flour dredged well into it. The great thing is to keep the affected surface of the skin from the contact of the air. The part will shortly get well, and the skin may or may not peel off.--_Const.i.tutional Treatment_. If the burn or scald is not extensive, and there is no prostration of strength, this is very simple, and consists in simply giving a little aperient medicine--pills (No. 2), as follows:--Mix 5 grains of blue pill and the same quant.i.ty of compound extract of colocynth, and make into two pills--the dose for a full-grown person. Three hours after the pills give a black draught. If there are general symptoms of fever, such as hot skin, thirst, headache, &c. &c., two tablespoonfuls of fever-mixture are to be given every four hours.