ACCIDENTS—EMERGENCIES—POISONS. 47 No definite rule can be given for the circumstances requiring them or the method of using them. An ordinary sewing needle will not answer, but a needle -with a cutting edge, such as saddlers and glovers use for stitching leather, can be secured, if the regular surgeon's needle can not be procured. The suture is of white silk, or possibly white flaxen thread might answer in an emergency. Surgeons now generally use fine wire of silver or iron, as metal irri- tates the part it comes in contact with less than a rough thread. The edges of the wound having now been properly brought to- gether, and retained there, the next thing is what is called the "dressing." All manner of things were once used for this pur- pose, under the impression that they were healing. They are now used by surgeons simply for protective purposes. The simplest are tlierefore the test. Hence water is now used, under the name of Water Dressing. As Isinglass plaster is softened by moisture, water can not, of course, be employed when this material has been used for retaining purposes. Take two or three thicknesses of what is called Patent Lint, if it can be conveniently had; if not, of old linen, or even old mus- lin, somewhat larger than the wound.* With a pair of scissors or a sharp-pointed knife perforate the folds, dip in cold water, and after squeezing out the excess, evenly apply to the wound. To retain in position, a strip or two of adhesive plaster can be thrown over, or a small roller (bandage) may be lightly applied. Keep the linen, or substitute, constantly wet, not moist, with water. Sometimes the wounded member is supported in a sling. This dressing is so simple, and at the same time so useful, that surgeons are apt to use no other in simple wounds; but unfor- tunately, it is so simple, that many persons, unless they are intelli- gent, have no confidence in it. They prefer pain-killers, lini- * By "old linen," many persons think the linen bosoms of old shirts is meant. For the purpose mentioned it is practically useless. An old damask linen table-cloth furnishes the best, and next to it, perhaps, old linen sheeting, quite coarse in texture, 48 AUCIOENTS—EMERGENCIES—POISONS. mcnts, herbs, and salves. Remember, the natural reparative pro- cess unites the parts, and the effort of the surgeon is only to put the parts in the position best calculated to favor this to advantage. All foreign matters, never mind under what name, as a rule, are obstacles, not aids, to this process of nature. In using water as a dressing, or application of any kind to the surface, if a sense of chilliness appears, its use should be discon- tinued for a time. As said elsewhere, the conversion of the liquid to a vapor requires much more heat than might at first be sup- posed. When the chilliness is observed, a little of some kind of stimulant may often be useful. If the pain is severe, sometimes opium, in the form of Tincture of Opium, (Laudanum) is added to the water applied. After a certain time, usually twenty-four hours, occasionally sooner, sometimes later, the outside strips of plaster holding down the lint should be divided, the parts removed, and the lint care- fully removed, after loosening it as far as is practicable by moisten- ing with tepid water. Should any portion be closely adherent to the wound, or any part of it, through coagulation of blood or escape of pus, and fail to become detached under delicate manipula- tion, with a sharp pair of scissors divide the lint as near as con- venient to the point of adhesion, letting the fragment remain, with the hope that by the next time separation can be secured. The adhesive plaster now only remains, and if it has been pro- perly applied, the condition of the wound can be easily determined. If there is no discharge of blood or other material, the plaster should be let alone, and another piece of lint and retaining strips applied, and kept wet with water as before. The next day the same examination should be made. If blood or pus is found, remove it with a soft piece of moistened sponge, being very careful not to disturb the wound or the strips of adhe- sive plaster. Should any strip have become loosened, remove it by catching hold of the extreme end and separating it gently and slowly until detached almflrt up to the line of the incision; then ACCIDENTS —EMERGENCIES—POISONS. 49 drop that extremity, taking up the other, and go through with the same thing until only the central portion over the wound remains to be separated. This is done to lessen the chance of tearing the wound apart, which pulling at one end of the strip would favor. With a little soap and water then remove the remains of tlie resinous portion of the plaster from tlie skin, dry gently and well, and apply a fresh strip as a substitute for the old, observing all the precautions suggested. These remarks apply, of course, to a simple incised wound, -when union takes place at once, or with but little suppuration (mak- ing of pus). This can not always be secured, from suppuration of the sides of the wound after the dressing has been applied, or an unfavorable condition, as it is said, of the blood. In such a case, the blood or pus must be removed once a day, as a rule, the surfaces of the wound kept together as much as possible, by adhe- sive strips, until a junction is effected. Do not use too much soap and water, as the only object of them is to better and more easily remove tlie foreign matters (blood and pus), which, if re- tained, act as irritants, but not to remove the reparative material poured out by nature for joining the separated surfaces. If, owing to the general health of the patient, or a new charac- ter given the wound by some unavoidable mishap during the course of treatment, there should be decided suppuration, the in- jury may require more frequent dressing, especially in hot weather. In such a case, if the wound has up to this point been with- out professional advice, it may be better to consult a physician, as a suitable tonic, a different diet, or even some local applications to the scat of injury, may be followed at once by an improvement in its appearance. A common accident is a " cut finger." Sometimes there is considerable loss of blood, but this usually ceases on bringing the edges of the wound together and then gently compressing the part. Do not use "plaster," but bring the surfaces together properly and apply a suitable bandage. 50 ACCIDENTS——EMERGENCIES——POISONS. "Arnica" and "liniments" can really be of little use, for get- ting between the wounded surfaces they tend to act as a thin wedge and discourage union. If there should be much pain, a little Laudanum (p. 130), Tincture of Arnica (p. 129), can be added to the water used for keeping the bandage wet. Under the classification adopted, have been included with incised wounds those instances where portions of tlie body have been cleanly cut ojf. Never mind what part it is, if the excision has recently taken place, the separated portion should be taken, rapidly freed from any foreign matter, and applied to the part from which it has been separated, in the position it previously occupied. Should the weather be cold, some raw cotton might be applied around it to preserve the warmth, and some measures inaugurated by which gentle and watoTm. pressure can be kept up for a reason- able time. After making all allowances for the remarkable stories told in reference to such things, there is no doubt tliat much can be said in favor of the practice and little against it; for if circula- tion and adhesion are not restored, it can be said that only a little time has been lost. Punctured Wounds. These vary in their importance, not only according to tlie depth of the wound and the structures penetrated, but according to the instrument inflicting them. The chief peculiarity and danger of these wounds is, that their nature does not afford sufficient facility for the escape of blood, other fluids, or foreign matters. The re- tained fluids decompose, or, by mere pressure, irritate the adjacent parts, or, by detention, enlarge the original wound. In punctured wounds the essential idea is to treat as an incised wound but their peculiar character, greater in depth than external area, requires a somewhat different plan of procedure. Remove whatever foreign matters have entered the wound, and apply a pad to the outer wound, so that it will, if possible, moderately and uni- formly exert some pressure along the deeper portion. The wound fills up with blood, and aa it can not escape externally, on account ACCIDENTS—EMERGENCIES—POISONS. 51 of the pad, it clots, and closes the open ends of the divided ves- sels, by pressing upon them. If the wound was made with a blunt- pointed instrument, it is practically, as far as union of the divided surfaces is concerned, a contused wound, which will next be alluded to, and will heal as such. If with a s7iarp instrument, the wound often heals as an incised wound; and if there is no discharge to require it, the pad may be left in position, as strips of adhesive plaster would be in an incised wound, without disturbance, until union of the divided surfaces is complete. In case much pain follows, with signs of inflammation around the injury, tlie dressing (pad) must be removed, to permit the escape of the results of inflammation of the deeper portions of the wound. Sometimes even tlie external opening of tlie original puncture is not large enough for the exit of pus and other dis- charges. In such a case, the surgeon must enlarge it until tlie re- quirements in this respect are properly met. Once a day, or oftcncr if the wound is discharging, it sliould have the dressing changed, to insure neatness and escape of pus. If certain structures are invaded by the puncture, the surgeon is often at a great deal of trouble to insure healing at the bottom of the wound first, to guard against the burrowing, as it is called, of pus between the muscles and other contiguous parts. Under the head of " Punctured "Wounds" may be mentioned a trivial set of injuries, quite frequent in occurrence and often at- tended with serious wraseizMcreces. They are produced by the run, ning in of a thorn, splinter of wood, or a piece of metal. The foreign body is pulled away in most cases, if it can be done readily; if it can not, it is let alone, as the phrase is, "to work out." In all cases, if a splinter or thorn, it should be got out. Not by poking at it with a needle, or something of the kind, which adds to the irritation, but by making an incision along its course, so as to expose it enough to get a sufficient hold upon it. If the incision should not permit a removal, a more ready escape has been made for the foreign body and any pus ("matter") that may form, 52 ACOIDBNTS——EMEBGENCIES——POISONS. thus lessening tile probability of the constitutional excitement ex- erted through the nervous system known as Tetanus (Lock-jaw). If the splinter is under tlie finger-nail, and can not be pulled out, do not waste the outside end by picking at it. The nail immediately above should be scraped as tliin as possible by a piece of glass, and then the thin nail overlying should be split with tlic blade of a knife, or an incision made on each side of the splinter, the little tongue of nail between the incision removed, exposing the upper surface of the splinter along its entire course. The restrain- ing pressure of the nail upon tlie foreign body is in this way gotten rid of, and at the same time an outlet for tlic products of in- flammation is given. A piece of lint, wet in water, to which a good deal of Laudanum has been added, should be applied, and kept wet with it as long as may be necessary. When the finger or hand, toe or foot, lias been pricked, particu- larly by any thizg foul, as a rusty knife or nail, a dirty piece of horn, or bone, the opening docs not permit the escape of the re- tained foreign particles, and inflammation results. The skin on these parts is so thick tliat it can not yield when the parts beneath are irritated and inflamed, and the inflamed portion, as it were, lightly bound up, or squeezed as in a vice, by tlic hard skin, and tlie almost always fatal condition of affairs known as Tetanus (Lock-jaw) supervenes in many cases. Whenever such wounds, to such parts, are received an incision should be made into the puncture, thereby providing a suitable escape for the blood, pus, ets.; and a piece of linen dipped in Laudanum forced into the wound. This can be done by almost any one, and may save serious trouble. In washing clothing, scrubbing and scouring, a fragment or even an entire nc^le is sometimes forced bcncatli the skin. Do not attempt to get it out, but. hold tlie part perfectly quiet until a surgeon can be procured. The slightest movement often places it beyond detection of the sight or touch. When this happens, ACOIDfi-ttTS—EMfiBGENCtBS—POISONS. 53 there is no occasion to bo alarmed, as the needle slips in between the muscles, and cannot even lie felt as painful. It does no harm there, as inflammation almost never results. Occasionally it is unexpectedly found near where it entered, and in a position favor- able for extraction. Contused Wounds. As the name implies, tlicsc are divisions of tlie tissue with con- tusion (bruising) of tlie parts. Some of the tissue is generally re- moved, the edges rough and irregular, but there is generally less gaping of the edges and less bleeding, than of incised wounds of the same extent. Tlie contusion impairs the contractility, as it is termed, of the parts, hence tlie less gaping of the edges; and the blood-vessels have been torn, and tlie roughened extremity of each vessel soon favors a clot there, hence the less bleeding. Contused wounds especially need careful cleaning out and re- moval of clots. The general procedure of treatment may be the same as for Incised Wounds, but with more watching for tlie occur- rence of decp-scatcd inflammation and sloughing away of the contused edges and surfaces during the latter process of suppura- tion. As soon as any alarming bleeding hns been checked by the application of ico or cold water to tho blood-vessels, or, if neces- sary, by pressure upon them, bring the edges of tlie wound together by strips of adhesive plaster; remembering, in applying them to a contused wound, that there must necessarily be inflammation of tlie bruised parts, with consequent discliarges. It is rarely that the entire wound is contused, although that may be its general character; so a portion of it, often tlie extremities, unite as an incision, leaving tlie rest of it to pursue ,1 different course. After sloughing (separation of the part whose vitality lias been de- stroyed by (lie contusion from tlie living portion) lias begun, poul- ti'ees are often of use in favoring the process. After due time, the parts damaged beyond repair become detached, and tlie contused wound appears as a cavity more or less superficial in depth, lined with a velvety surface, more or less obscured witli pus. After a 64: ACCIDENTS—fiMEftGlWClES—fOtSOSS. while the gap is filled up by these granulations (new, but imma- ture flesh). When these granulations get above the surrounding edges of the wound, before they become consolidated, the appear- ance is popularly termed "proud flesh," and wrongly supposed to prevent the healing of the wound. These granulating surfaces are sometimes stimulated to increased activity by the application of some simple stimulating oint- ment, or by gently brushing once a day, by means of a camel's- hair pencil, or the floating edge of a clean, soft feather, with a solution of Sulphate of Copper (blue vitriol), say a piece as large as a grain of coffee, dissolved in a couple of table-spoonfuls of water. Lsicerated Wounds. Lacerated "Wounds are made by rending or tearing (lie parts, rather than by cutting, as in Incised, or by breaking, as in Con- tused Wounds. The treatment follows tliat of the latter named injuries, to which they bear a strong resemblance in most re- spects. The chances for union are subject to about the same probabilities, and should be favored the same way. Tlicse wounds often occur in the scalp; sometimes a large piece is de- tached, and left hanging by a small attachment. Never, under any circumstances, permit the fragment to be removed, as the scalp is so largely supplied with blood-vessels, tliat injuries there of the most unfavorable aspect to an ordinary observer arc often rapidly and completely repaired. Poisoned Wounds. This includes all wounds into which any poison, venom, or virus is introduced. Tlie wound is not always made at tlie time of tlie Introduction of the poison, but often exists previously. Tlius, a scratch, fissure, or ulcer may exist on the hand or other part, and afford entrance to alkalies, acids, or other such irritants. When auch a wound of tlie skin exists, and may be exposed to any irri- tating substance, great care should be exercised to prevent trouble ACCIDENTS—EMERGENCIES—POISONS. 65 arising. Persons with such injuries to the hand have suffered most severely from skinning animals which have died of pleuro- pneumonia and other diseases. Physicians often decline making a post-mortem examination because a wound exists on the hand, and many have died under the circumstances, because they did not ab- stain. If a poison should be introduced, and at once observed, before absorption by tlie system has taken place, a stick of Nitrate of Sil- ver (lunar caustic) should . be thurst into the wound, or, what is more certain would be to heat a large nail red hot and force the end into the opening. Another variety of poisoned wound is when the poison is intro- duced at tlie time of the injury, as in the case of bites and stings of insects, and the bites of serpents and animals. In this latitude, there are but few insects known whose bites can really be considered poisonous. A swollen face which can not otherwise be accounted for is often attributed to the bite of a Spi- der. Trouble rarely results from it, and when it does it will often bo safe to ascribe a portion to the condition of the general health at the time. Tlie bites of certain flies have been followed by symptoms of local poisoning, but it would be well, should it hap- pen, to know where tlie fly had been just before. The stings of insects, as Hornets and Bees, are always painful, and sometimes followed by great swelling. A stimulating applica- tion to the injury, as a drop of Aromatic Spirits of Ammonia, will often afford the greatest relief. A pinch of common table salt, dampened with water and rubbed in, is very useful for the same purpose; likewise a slice of onion rubbed on gives almost instant comfort. There are few serpents, likewise, in this latitude,, whose bite is followed by poisonous symptoms. The bite of the common Rattle- skake is a well-known exception to the rule. Where a person has been bitten by one of these serpents, there is usually little time to be lost. If it is the hand or other accessible part, tho 5^ ^'SMim—KMBBaEHcitEg—fotgoifg. fold of the skin containing the puncture should be gathered be tween the teeth, and the strongest suction of the lips used to ex tract the venom. If there is no laceration or other injure to the Am of the lips, or the mucous membrane of the mouth, it can be done -with impunity. The symptoms are a slackened action of the heart, indicated by a feeble pulse and other appearances of prostration, indicating the free use of stimulants. Marvelous stories are told of the quantities of whisky and brandy taken under these circumstances' by persons not addicted to the use of them. Either are usually to be had on such occasions, and it might be wise to give of them freely at brief intervals, until symptoms of slight intoxication ap- Pear. As the heart is much enfeebled in its power, it would read; v suggest that the person bitten should be made to lie down on 1 le^'taLT"1 is the position where thc strength of the lleart -s BITES. Independent of the consideration whether any ^ „,, ^ introduced through the wound, Bites may be regarded as a crated as well as a wntwed wound. There is usually a good deal of sloughing of the bitten parts, and no small amount of pain owmg to the nature of the wound. Care should be taken to re. move from the wound any particles of clothing, should any have been forced ,nto ,t, then wash out with tepid water with a little Castuesoap. Usually the part is so much conned that no effort is made to secure adhesion of the opposite sides of the wound. but water dressing is at once applied, and suppuration and slough ing awaued. The pain is often quite severe, owing to injury num. should be added to the water used as the dressing. Bites of Dogs. Rabid dogs are much less frequent, perhaps, than is generally thought; and a rabid dog, it may be supposed, might bfte many