. 87 of the body are clearly cut off; (2.) Punctured wounds, as stabs, pricks, or punctures; (3.) Contused wounds, which are those com- bined with bruising or crushing of the divided portions; (4.) Lacera- ted wounds, where the separation of tissue is effected or com- bined with tearing of them; (!>.) Poisoned wounds, including all wounds into which any poison, venom, or-virus is inserted. Any of these wounds may be attended with excessive Twnwrrliagt or pain or the presence of dead or foreign matter. As all wounds tend to present several common features, a few words will be said about them before describing the distinctive characteristics of each. The first is-hemorrhage (bleeding). This depends, as to quantity, upon several conditions, tlie chief of which is the sine of the blood-vessels divided; and, to a degree, upon the manner in which it has been done. A vessel dividsd with a sfiarp instrument pre- sents a more favorable outlet for the escape of blood than one that has been divided with a Uunt or serrated instrument, or one that has been torn across. Except in the first named, the minute fringes or roughness necessarily left around the edges of the vessel at the point of division retard the escape of blood, and furnish points upon which deposits ^ ^ of blood, in the shape of jjjj| A I clots can take place. Hence j^^S^i/ all other things being equal, y""^y and Incised wound is usually ^ t attended with more liemw- (?\ ^ \ rhage than Contused or Lac- <^^^^'»^^\ |-^l I m Personal peculiarities of <^~^|i- \ \ ^^ \^ ^JUs'6' the patient, and the health ^^..,,,.,,, -/^[aL_^~-^--- or disease of the wounded ^^^fe;- y part of the body, may exert ^^^^* much influence upon the hem- orrhage. Usually it ceases in a short time by the coagulation
38
ACCIDENTS——EMEnCtKNOIER—POISONS.
(clotting) of the blood in the severed extremity of the vessel without further attention than the application of cold, which favors contraction of the blood-vessel divided, as well as those leading «, the injured part. Should an artery or branch have been divided (indicated by a .purtfng of a spray of bright blood at each beat of the heart), the bleeding may not cease at once To stop it, the firm pressure of the finger for some time to the point of division should be used, to diminish the size of the vessel at that point, until a clot is formed there. Sometimes, pressure to the supposed seat of the injured vessel does not reach the artery. In such a case, the pressure must Be used to sotae known trunk between tlie original supply of the blood and the injured branch. Thus, if the finger or the toe is the seat of the arterial hemorrhage, firm pressure applied each,/^ of the finger, close to the hand (as in the cut) or toe, close to the \^ / '^a- foot> ''""Presses the arteries passing along to be distributed ^^^^t. ^^ to the extremity. If the hand t^A ^ ^\ or 'foot is the seat °^ '".^"T* ^H W^ / P"'88"'^ on the wrist, over the A I Ro'nt where the artery is felt ^.^i^^^^^'/ for thc "pulse," or at the in- >"^' /jiOfcf X. sld® of tht! aDkle> ''"11 material- JH^ li^^E^^ ly rctard the pass^ of the _JF ^if^ ~ b]ood ^yoDd those points. JB^^^ '^i^^) 1 ^l1011!*! pressure by the thumb at these suggested points not ^^^S";7 answer the purpose, the main trunk of the artery, higher up should be compressed by a tourniquet. Before this is done, it is always well to place the person injured flat on his back, and hold the arm and hand in a perpendicular position for a time, as the heart will then be unable to throw the blood with its usual force to the extremity. Pressure applied by the fingers, with
ACCIDENTS—EMERGENCIES—POISONS. 39 broken ice in a towel bound round the arm, in conjunction with the elevation of it, will often stop the hemorrhage, or retard it, until professional aid is secured. If the foot is the seat of the injury, elevate the whole limb in the same way, applying pressure and pounded ice on the same principle. In wounds of the scalp, there is usually much loss of blood, ow- ing to tlie abundant blood supply of that part. The firm skull below offers a good point for pressure, and the vessel rarely fails to be compressed if the thumb is applied over the point of divi- sion of tlic severed vessel. The ammmt of blood actually lost is apt to be much over-esti- mated. Quite a small quantity will seem "a half pint" if distri- buted over tlic clothing, and a gallon of water requires no great amount added to it to give it quite a blood-red color. It is esti-
NOTE.—The arm and forearm, with dotted lines, indicate the course of tlie arteries, and points at which pressure can be most judi- ciously applied. The arrow points the course of the current of the blood of the artery, from the heart to the extremities. 40, AcCtSESTS—BMER6BNCIES—P0l80t?8. mated that about one eighth of the weight of the entire human body is blood, in other words, the quantity of blood in a human body weighing 144 pounds would be about 16 or 18 pounds. Of course, this amount, nor half it, perhaps, can be withdrawn from the vessels without fatal results ; but it is merely mentioned to show that the entire quantity asserted to exist by physiologists is much larger than is popularly supposed. When hemorrhage from a divided blood-vessel is seen, there is usually much more apprehension and excitement about it than is warranted. This figure shows the method of exerting pressure by the fin- gers along the course of the Brachial Artery; between the divided vessel and the heart. If the wound should be in the arm above the point indicated bv the fingers, or in the axilla ("arm-pit"), pressure could be made
NOTE.—The arm and forearm, with dotted lines, indicate the course of the arteries, and points at which pressure can be most judi- ciously applied. The arrow points the course of the current of the blood of the artery, from tlie heart to the extremities. ACCIDENTS—EMEiiafilrclts—forgone. 41 by the thumb, a blunt stick, properly protected, or the handle of a dcor-key upon the Sub-clavian Artery, which passes, as the name suggests, along under the clavicle ("collar-bone") and down the arm, where it is called the Brachial Artery—just spoken of. Fur- iher down the arm at the elbow, this vessel is subdivided into two others, each following a bone of the forearm to the wrist. At the wrist, over one bone, near the surface, the pulsation of the heart is sought by the finger of Hie pliysician. Permanent pressure exerted by means of a temporary tourni- quet to the Brachial Artery is spoken of on the other page. A common folded handkerchief, with a firm, sharply-defined knot tied at the middle, a long strip of muslin torn from a shirt-sleeve, or a suspender, with a suitable knot in it, is rather loosely tied around the arm, and the slack taken up by twisting with a cane
NOTE.—The thigh and groin, with dotted lines, suggest the course of the large arteries, and point at which pressure can be most suc- cessfully used. The arrow indicates the direction of the current of the blood of the artery, from the heart to the extremities. 42
ACCIDBNTS——EMERGENCIES —POISONS.
or stick until the knot, kept over tlie vessel, exerts enough pres. sure to prevent the passage along it of the blood. This is easily done if you proceed to it quietly, without talking.- especially if previously practiced once upon the extremity of a friend. The method of exerting pressure by the fingers along the course of the Femoral Artery, between the wound and the heart. Sometimes it is easier to find the artery nearer the surface, at a point along the dotted line, or a little higher up toward the groin. The two thumbs placed together furnish firm resistance; and a blunt stick, suitably protected, will often answer to keep up the pressure until a tourniquet can be extemporized. Tlie muscular condition of the entire leg docs not permit tlie pressure of the fingers to be as successfully exerted along the main arteries, as in the case of the arm just spoken of. This cut presents the tourniquet made as directed on page 41,
NOTE.—The thigh and groin, with dotted lines, suggest the course of the large artery, and point at which pressure can be most suc- cessfully used. The arrow indicates the direction of tlie current of tlie blood of the artery, from the heart to tlie extremities. ACCIDENTS—EMERGENCIES—POISONS. 43 by getting a large firm knot in a handkerchief, or any thing else of the kind. A small pebble has often been introduced for the pur- pose, into the knot, with success. Twist the ligature with the leverage obtained by passing under it a cane or stick. Get the knot over the artery—keep the knot there, and tighten until the pressure of the knot closes the vessel. It is much easier done tlian imagined, especially if the individual lias some day spent three minutes practicing the preparation of the ligature, and its application over the course of the artery of a friend. There is no necessity for the alarm often shown, especially as it obscures the judgment of those who, if they would but reflect a moment, could much more serve the true interests of the sufferer by keeping cool and collected. Pain, it may be said, accompanies all wounds, for it is almost im- possible to sever a blood-vessel without severing nerves. It is usually much less severe tlian might be thought, and as little can be done immediately to relieve it, other prominent features of wounds in general will be spoken of. Fainting, after a severe hemorrhage, or in "nervous" persons, frequently requires attention, after tlie loss of blood has been placed under control. Often it is due to tlie sight of the blood, and an undefined apprehension as to the extent of the injury on the part of the wounded person. The latter feeling is in part derived from the excited and frightened appearance of those about. A per- son witli a wound attended with hemorrhage, ignorant of its extent and consequences, seeing his friends, upon whom lie must neces- sarily rely for succor, in such a state of alarm that he can expect little real aid from them, can not be said to be in a comfortable state of mind—and is apt to faint. The symptoms of fainting are too well known to need descrip- tion here, especially as something is said about them under the head of "Shock," p. 23. The person suffering from fainting should be placed on the back, if possible, the head slightly raised, 44 ACCIDENTS—liMEtlGEHciaS—t'OtSoNS. if at all, obstruction to the circulation in the shape of cravat and collar removed, and any obstacle to perfect movement of the chest likewise dispensed with. For an adult, a tea-spoonful of Brandy in a little water, may be given every few minutes, until consciousness and restored action of the heart is observed. Twenty drops of Aromatic Spirits of Ammonia, in a tea-spoonful of water, at short intervals, say every five or ten minutes, is quite as useful, but not always as easily secured. Too mwh stimulation in such a case might do liarm, by causing tlie heart to send tlie blood with such force as to disengage the little clots spoken of at the divided ex- tremity of the vessel. If the loss of blood has been great, or the condition of tlie pa- tient before the receipt of the injury such that the loss can not be rapidly restored, the fainting may not rapidly or completely dis- appear. In such cases, beef-tea and easily digested nutritious food, and even tonics, will probably be recommended by tlie medi- cal attendant. Foreign matters, such as have been introduced into the wound at the time of the injury or subsequent to it, of course, should be care- fully removed. Having thus referred to certain features common to most wounds, the special, and what may be called tlie distinctive points of each class, according to the arrangement herein adopted, will now be given. Incised Wonmis. After the hemorrhage ceases, and the clots, with any foreign mat- ter, have been carefully and gently removed, by a judiciously direct- ed stream of water from a sponge, the separated surfaces and edges of the wound should be brought carefully together. To re- tain them in position until union has taken place, strips of adhe- sive plaster may be used. This being a resinous preparation, it soon becomes dry, and useless for tlie purpose. Hence get but little at a time, and replenish with recently prepared as often as is necessary. In cities, it can usually be had good from the large ACCIDENTS—EMERGENCIES—POISONS.
45
shops, where large sales prevent an accumulation of stock. With a pair of scissors, cut it lengthwise, into uniform sized strips of about a quarter of an inch in width, or even less in some instances. These can be subdivided in length, so as to extend across the . wound, and far enough on __ ^ each side to secure a suit- able Twid on the skin. |^;T\ ^P^T "Warm the plaster side of j| ,^\ ^ \ the strip at the fire until VtXw)^' M it becomes thoroughly and ^(^^^sas.'j^^y^^^ mr uniformly melted, then be- ^j^|^^^^^^^^^ ginning with one end (re- ^('t^^j^^^ ^ collecting that the centre ^f\ ^Ilife- ^^fc^' of the strip should cross ||| ^ ^^^y^^ the incision) rapidly and || | completely attach it to the ^ jj ^^illll- skin, as a rule at right an- ||j| j|» gles to the line of the cut. ^||; ^ As the middle part ap- 'i,^ ' proaches the wound, with the fingers bring up the skin toward the incision, from the other side, upon which the other half of the strip is to rest; then rapidly attach the rest of the strip. If this is not done, the strip of plaster will be found in folds, owing to tlie yielding of the soft skin beneath, and the edges of the wound separated. If one strip will keep the edges approximated along the whole length of the wound, no more is needed. If not, use others. Where more than one is used, the edge of the strip should be brought across a short distance from the extremity of the wound, so as to permit the ready exit of blood or pus. Con- finement of either or both by the plaster, or anything else, favors "burrowing," as it is called, and consequent separatum, of the wounded surfaces. On the scalp, the face of men, and the extremi-
46 ACCIDENTS—EMERGENCIES — POISONS. ties of some persons, the hairs must first be shaved off the skin, or the plaster will not remain attached. Most persons, in using adhesive plaster on a wound, apply a large piece, or several small pieces, so as to completely cover it. This must not be done. A few drops of blood retained after swh an arrangement, even when the edges of the woun 1 have been carefully brought together, undergoes decomposition, irritates and inflames the parts, loosens the plaster, and changes what otherwise should have been the result of the accident. Adhesive plaster is the best for use, but as it is not portable, often in an emergency it is easier to get Isinglass plaster. This is a thin tissue of silk spread on one side with a solution of isinglass or other gelatinous substance. -Heat is necessary to soften adhesive plaster; but moisture dissolves Isinglass plaster. As in most wounds there will be some liquid discharged, it can be seen at a moment's thought why Adhesive plaster will remain attached, while Isinglass plaster will become detached. When Isinglass plaster only can be procured, it should be cut into narrow strips, the adhesive side moistened, and then applied as above directed. Tlie black variety of Isinglass plaster, usually sold in small envelopes, is scarcely fit, as a general rule, to be used. Speaking of plasters, the writer will say that on one occasion, where none was to be had, the edges of an incised wound of some length were successfully brought together, and held there, by a postage-stamp divided lengthwise into four strips. In shaving the face, cuts are sometimes made which bleed to a troublesome extent. A crystal of common alum should always be kept with the apparatus, the bleeding absorbed by a fold of the towel, and then, before the blood can accumulate, thrust into the incision the edge of the crystal, holding it there a few minutes. If the bleeding continues, it is because the alum does not reach the divided vessel, and the wound should be wiped out until it can. If the incision is deep, or there are not good points for attach- ment of the plaster, sutures are often employed by the surgeon.