Accidents



The after effects of burns and scalds upon the body generally have been divided into three stages:-

1. Shock and collapse.

2. Inflammation.

3. Suppuration and sepsis.

The stage of shock usually lasts from twenty-four to forty-eight hours, and varies in severity with the “superficial area” of the body involved, the degree of the burn, and the age of the patient. Shock is commonly most profound in infants, though pain is often not marked, even in the gravest cases. The pulse is rapid and frequently imperceptible at the wrist; the temperature is lowered and often to such a degree that the clinical thermometer is unable to register the fall; the surface of the body is cold and covered with sweat; thirst is extreme, and the child constantly cries out for something to drink.

TREATMENT- The majority of patients when first seen are in a state of profound shock, urgently calling for treatment. Every effort must be made to get the patient warm and to restore the failing circulation. In the case of a child as a substitute for the some what inefficient hot-water bottle, a thirty-two candle- power electric lamp is placed beneath the cradle which covers it and the temperature of the air can thus easily be maintained at about 103 degree F., until shock has passed off. “Normal saline solution” ( a teaspoonful of common salt to a pint of water) at l05 degree F. should be very slowly injected into the rectum every few hours in quantities varying from two ounces for a small child to a pint for an adult. Half a drachm to half an ounce of brandy may be conveniently added to the saline, especially when it is difficult to administer everything by the mouth.

One of the most satisfactory solutions to employ as primary dressing is Picric acid, 1 1/2 drachms, absolute alcohol 3 ounces, distilled water 40 ounces. Gauze or lint should be lightly wrung out of this solution, and applied all over the burnt areas, which are then covered with antiseptic wool and bandaged. A point to be insisted on is that no water proof covering of any kind should be used. Dryness of the dressing should be aimed at. Picric acid seems to have in some cases at any rate, a fairly marked action in relieving pain. It possesses also the property of encouraging and assisting the growth of the new tissue.

A most important object to be attained is to cover the injured part with some suitable material that shall exclude atmospheric air. This can only be attained when the skin is unbroken. All blisters must be snipped away. One of the following local applications is recommended:-

1. Carron Oil- A combination in equal parts of linseed oil and lime water. Named from the great Carron iron works, where it is used by the workmen when suffering from burns.

2. Carbolic Acid and Olive Oil- One part of the Acid (as prepared for medical use) to twelve parts of Olive Oil, is found to be invaluable in most cases, slight or severe. It is cleaner, more easy of application, and more soothing than most other remedies. One layer of lint put on at first should not be removed; this should be kept saturated by the removal of outer layers from time to time. When the wound is healed it is easily and comfortably dispensed with. As a domestic remedy, it is recommended to be kept always ready for burns and scalds, just as Arnica, Calendula, etc., are kept ready for other kinds of accidents.

The application of a lotion of Urtica Urens (twenty drops of the tincture to an ounce of water) in the simplest cases, or of Cantharides (ten drops of the tincture to an ounce of water) when blisters are forming, by means of cotton-wool, is of great service. Kreas. is also sometimes useful.

3. Soap- Moisten white or brown soap in water, and rub it on a piece of linen so that the soap forms a coating on the linen as thick as a shilling, and larger than the wound it is intended to cover, so that it may the more perfectly exclude the air.

4. Flour or Starch- One of these may be used as a substitute in the event of either of the above not being at hand. Wheaten flour and finely-powdered starch should be uniformly and thickly applied by an ordinary dredger, so as to form a thick crust by admixture with the fluids discharged from the broken surface, thus excluding the air; and repeated when any portions fall off. Flour is, however, inferior to Carron Oil or Carbolic Acid, and its after-management is more difficult.

The points of greatest importance are immediate application of the local remedy, complete exclusion of atmospheric air, and infrequent changing of the dressings not, indeed, until they have become loosened or foetid from the discharges. A complete change of dressing often causes pain, depression, and the detachment of portions of the new skin, and so retards the cure.

When, after the removal of the first dressing, ulcers exist, Boracic ointment is the best dressing. Calendula or Glycerine cerate, or a mixture of Urtica Urens and Olive Oil (one part to six), are also suitable applications. Any discharge should be carefully removed, and the parts kept as clean as possible.

Internal treatment, except in slight cases, is always necessary, and must be suited to the part injured, its extent, and the constitutional symptoms present. As a general rule, Aconite, early, does good, by allaying febrile symptoms, mitigating pain, and moderating reaction. Arsenicum is valuable if ulcers form, or if the burn present a gangrenous appearance. Secale and Carbo V are also useful in the latter condition.

239. Contusion Bruise.

DEFINITION- An injury inflicted on the surface of the body by mechanical violence, without laceration of the skin. It may be either slight, involving only the rupture of minute subcutaneous blood-vessels, and perhaps the tearing of some muscular fibres, or a large blood-vessel may be torn; or even disorganization of the tissues beneath the skin may be caused, as from the dull force of a spent cannon-ball. The remarkable properties of elasticity and toughness possessed by the skin often permit serious damage to its underlying structures while it remains entire.

CAUSES- A blow from a hard, blunt body; forcible pressure between two forces, as a wheel passing over a limb; or, indirectly, as when the hip-joint is contused by a person falling on his feet from a height.

TREATMENT- In the less severe form of bruises which alone are prescribed for here, the object should be to excite, as speedily as possible, the absorption of extravasated blood. To this end the bruised part should be raised, and a warm Arnica lotion (one part of the strong tincture to ten of water) immediately applied by saturating lint with the lotion, and covering it with oil- silk, to exclude the air. The value of this application is undoubted, and happily is now becoming generally recognized. If the patient have a predisposition to Erysipelas, Hamamelis should be used instead of Arnica In contusions involving glandular structures, as the female breast, Coni. is recommended; or when the covering of bone, as of the shin, is involved, Ruta. When pain or tenderness has subsided, a bandage should be applied.

ECCHYMOSIS- This is discoloration of the skin following a bruise, and is produced by extravasated blood under the skin. It is first of a reddish colour, but speedily becomes black. During recovery, the parts change, first to a violet colour the line which defined the bruise becoming indistinct afterwards to a green, then yellow; and thus, sooner or later, according to the health of the individual, or the quantity of blood poured out, the discoloration disappears. Black-eye is a common instance of ecchymosis.

Arnica lotion has great power in preventing this condition if used immediately after an accident. When extravasation has already occurred, Hamamelis lotion (one part to six of water) is more appropriate.

240. Sprain Strain.

DEFINITION- An overstretching of the ligaments and tendons generally with a rupture of some of their fibres.

TREATMENT- The immediate treatment consists in the application of hot water, as hot as can be borne, until the pain is considerably modified, followed by a compress of cloths moistened with the lotion of Aconite, Arnica, Rhus, Ruta, or Hypericum and covered with flannel. The remedy used for the lotion may be also taken internally.

Aconite in alternation with Rhus, may be administered when the joint becomes swollen and painful; and when constitutional disturbance attends the injury.

When the swelling and pain subside strong adhesive plaster is applied to support the injured parts, and do away with the necessity of lying up. It should be worn for two or three weeks as the injury may easily be re-induced and then cure becomes both difficult and tedious.

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241. Wound.

DEFINITION- A forcible solution of continuity of the soft tissues.

Wounds are termed incised, when made by clean-cutting instruments; punctured, when the depth exceeds the breadth, as stabs; lacerated, when the parts are torn and the lips of the wound irregular; contused, when effected by bruising (see Section 227). We may also add that a gun-shot wound is termed penetrating, when the shot is lodged in the part; perforated, when it passes through it; and, according to law, burns.

Edward Harris Ruddock
Ruddock, E. H. (Edward Harris), 1822-1875. M.D.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.

Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."