For poisoned wounds, see Section 216.
TREATMENT- The following are the chief points:
1st- To arrest the bleeding- In most cases, the elevation of the part, keeping the bleeding surface uppermost, and pressure, will suffice. A Calendula lotion tends to arrest haemorrhage and checks suppuration. In severe wounds involving arteries, the parts should be laid open by a surgeon, and the wounded vessels ligatured.
2nd- The removal of foreign bodies- Dirt, hairs, glass, clots of blood, etc., should be speedily removed by forceps, or allowing clean water to trickle over the wound.
3rd- To bring the injured parts into nice apposition- Any muscular fibres likely to prevent complete union should be relaxed or divided, and after the sides of the wound have been accurately adjusted, they must be kept so by strips of adhesive plaster, first applied to that side of the wound which is most movable, and then secured to the other. But, in extensive wounds, where plaster would be insufficient, stitches should be employed.
4th- To promote adhesion- To secure this, the part should be elevated and kept at rest, and if the injury be severe, the patient should remain in bed.
5th- When a wound is dressed, say once in every twenty-four hours, a rag or sponge wetted with warm water should be laid over the dressing, so that it may be removed without the risk of disturbing the surfaces which may have partially united. Lotions may often be renewed by removing the oil-silk only, and dropping lotion on the rag or lint, or pouring it on by means of a spoon, and then replacing the oil-silk.
6th- To control dangerous bleeding, as from a sharp-cutting instrument. When blood flows in a steady stream, and is dark- coloured, it is from a vein, and can generally be checked by elevating the part and applying pressure, such as a pad of gauze or lint held firmly in position by a bandage. A few thicknesses of material, with steady compression, are more efficient than heaping on a large quantity. Bright-red blood, flowing in jets, is arterial, and similar means must be adopted as just pointed out, unless the bleeding be excessive, in which case a hand- kerchief should be tied round the limb, near the wound, and between it and the heart; a stick inserted under the handkerchief and a firm compress over the course of the blood-vessel; the stick should then be twisted until it stops the circulation, and, consequently, the bleeding. But such means are only temporary, as wounded arteries of size require to be ligatured by a surgeon before bleeding can be permanently arrested. If no surgeon can be obtained, a clever manipulator should grasp the wounded artery with a pair of forceps, and draw it slightly and gently forward, so that it may be securely tied by means of a strong ligature of silk; or haemorrhage may be arrested by twisting the end of the artery round and round until it will not untwist itself. The latter method is designated torsion.
7th- Should a wound or bruise be followed by constitutional disturbances fever, chills, and throbbing in the parts internal medicines should be administered.
Arnica (as prepared for internal use, and Aconite will generally meet the requirements of such cases, and should be administered every three hours, in alternation, for several times; or if the injured part be very painful and swollen, with congestive headache, etc., Belladonna may be alternated with Aconite or with Hep-S. or Silicea when suppuration is established.
CUTS- The treatment of this variety of wounds, if only of moderate size, is generally simple. The edges of the cut should be brought together and maintained so by narrow strips of strapping-plaster; then, if necessary, a bandage applied over the plaster. In two or three days the plaster should be removed without disturbing the union, and replaced by new. If, however, inflammation and pain occur, the application of lint saturated with Calendula lotion, covered with oil-silk, and a bandage over all, is necessary.
242. Foreign Bodies.
TREATMENT- Any foreign body in the flesh glass, a thorn, splinter, broken needle, etc. should be removed as quickly as possible, by forceps, etc. or allowing water to trickle over the wound.
FOREIGN BODIES IN THE EYE- If sand, flies, or hairs are between the lids and the globe, they should be removed immediately by bathing the eye; but if the substance cannot be removed in this manner, the eye should be gently wiped with a soft, moistened handkerchief, or with a feather, or a bent bristle may be used, the two ends being held by the finger and thumb. In one of these ways, with a little perseverance, the offending substances may generally be removed.
If small pieces of flint or iron become fixed in the front part of the eye, they should be most carefully picked out with a needle or the point of a lancet. If the intruder be in the upper eyelid, the lid should be everted.
Mortar or lime is rapidly destructive. If seen immediately, the eye should be washed with a strong solution of sugar, or a few drops of oil instilled. Water must never be applied to these cases. The lids should be everted, and every particle of lime removed. Grains of gunpowder may be removed with plain tepid water.
When the foreign body is removed, a weak Arnica lotion should be applied to the eye by means of lint or soft linen, and covered to prevent evaporation.
FOREIGN BODIES IN THE EAR- Peas, stones, slate-pencil, glass beads, shells, etc., are sometimes found in the ear-passage; or cotton-wool which has been forgotten, or a portion of which only has been removed, is occasionally met with. If permitted to remain, such substances rarely occasion any untoward symptoms, although they may continue a long time till uneasiness in the ear leads to an examination of the tube. Any such body should be removed as gently as possible, either by syringing the ear with warm water, or other simple means. One caution is necessary respecting the use of the syringe, which is that when the foreign body is known to be of a vegetable nature, the moisture may cause it to swell, and so impede its ultimate removal. An insect will instantly retreat if a drop of sweet oil be let drop into the ear. If the foreign body cannot be removed by gentle means, the case should be submitted to a surgeon, so that a careful examination may be made by means of the ear-speculum and the aid of sunlight or a lamp. This examination is necessary for two reasons; for although a foreign body, if present, may generally be seen without such means, still the absence of such body cannot be affirmed without a complete exploration of the tube. Further instances often occur in which surgeons are requested to remove a foreign body when non exists, and a proper examination with the speculum would often prevent any injudicious meddling with instruments. Any soreness or inflammatory symptom that may ensue from the foreign body, or the attempts at extraction, should be met by the application of a week Arnica lotion (six drops of Arnica O to two tablespoonfuls of water).
243. Fracture Broken Bone.
A few words on the immediate management of cases of broken bones seem necessary in this Manual, as a surgeon is not always just at hand, and it is necessary to be prepared to act till surgical attendance can be had.
SYMPTOMS- A fractured bone may generally be detected by having felt or heard it snap; by some deformity, such as bending or shortening; by the fact that if the upper end of the bone is held firmly by the hand, the lower part may be moved independently; also by a grating noise (crepitus), which may be heard if the broken ends are rubbed against each other. Further, there will be pain, loss of power of the broken part, and other symptoms. Fracture is said to be simple when there is no wound of the skin communicating with it; compound when there is such a wound.
CAUSES- Mechanical violence is the most frequent; but muscular contraction is sometimes a cause. Old age, some diseases, excessive drugging with Mercury, and prolonged disuse of a limb, render bones liable to fracture from trifling causes.
IMMEDIATE TREATMENT:-
A BROKEN LEG should be fastened to the whole one by a handkerchief at the ankle, and above and below the knee, before the patient is removed.
A FRACTURED ARM requires the immediate support of a sling, which may be made by a handkerchief or towel and fastened around the neck.
BROKEN RIBS require a flannel bandage about two hands broad, round the chest, with shoulder-straps to keep it up. A rather tight-fitting bandage lessens the movement of the chest in breathing, and is a great comfort. Flannel is better than linen, as it is more elastic.
The patient must be moved gently, and special care taken to prevent the broken bone from being forced through the flesh and skin. He should be placed on a stretcher or litter, and taken to his home, or to a hospital. A litter may be made of a couple of poles and a horse-cloth or sick; even a door or hurdle may serve the purpose. Placing him on this, and carrying him by two men is much better than removal in a cart or carriage. It is important not to be in a hurry, as an injury is often greatly aggravated by carelessness or too hurried measures. When a surgeon is within a moderate distance, after making the patient as comfortable as possible, it is better to wait a little, so that he may superintend the moving.
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."