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In lacerated wounds care should be taken to remove any foreign body that may be in the wound, by washing with a warm antiseptic, such as boric-acid solution, or using sterile forceps, tweezers or pliers to remove the object. A sterile dressing should be applied after the wound is clean, this dressing to be kept wet by additions of the hot antiseptic solu¬tion. If the wound is of the scalp and a flap of scalp hangs loose, this should be washed and placed in position, then a head bandage applied. Where parts are crushed or mangled, as in railroad and machinery accidents, elevation may not be suffi¬cient to stop the hemorrhage, so the use of a tourniquet may be necessary.
The clothing should be cut away around the wound, then treatment given for the shock that will usually have been sus¬tained (see Shocks page 3052), the parts washed with a mild antiseptic solution, covered with some clean oil or vaseline, the several parts replaced as well as they can be, then secured, along with the neighboring joints, to a split. Parts partially severed should be adjusted to position after cleansing, for with the physician’s help they may be saved. If shock has de¬veloped the patient should be treated where he is, or after re¬moval to a safe and comfortable place, until he has recovered. No effort should be made to undress or to attempt to bathe the patient.
A few suggestions relative to various kinds of wounds will be appropriate. In the case of incised wounds, the skin being broken smoothfy, it is well, after the bleeding has stopped and a semi-permanent dressing is to be applied, to bring the wound edges together so union will take place readily and a small scar result. Adhesive straps may be used to hold these edges together, at the same time holding in place the gauze or lint dressing. A “cocoon” dressing may be used on smaller wounds: cover the wound with a small pledget of gauze or cot¬ton and cover this with a single layer of gauze large enough to extend half an inch beyond all sides of the wound, then paint this edge and the adjacent skin with liquid collodion, which secures the dressing to the skin, yet allows some air to reach the wound. ~No final dressing should be given these wounds until it is determined that no blood-vessels, nerves or tendons have been severed. Severe bleeding will require either pressure, cold applications or the tourniquet. If a nerve is cut, paralysis of motion or sensation will be below the injurj*. If a tendon is severed, its muscle will be rendered powerless. A doctor is required for all these conditions.
Treatment of Wounds. Wounds of all kinds causing loss of blood should have prompt attention, otherwise there may be serious results, even loss of life. Minor wounds should be allowed to bleed moderately, the blood serving as an excellent cleansing agent and providing antisepticizing elements. Butif the bleeding is more than slight the hemorrhage should be arrested by the methods given under Hemorrhage.
If symptoms of faintness or shock develop the patient should be laid on his back with the head low, heat should be applied externally, and if convenient, a hot drink given. However, do not give alcohol, and preferably avoid coffee and other stimulants.
Apply a clean dressing to the wound and secure it with a suitable bandage. Boracic lint is the best dressing, but if not available use any clean white material. Colored material should not be used when the skin is broken.
“Wound Fever” does not always develop even in large wounds; in fact it will be present only in slight degree if at all unless there is some degree of infection. The main forms of wound fever are: tension fever, due to collection in a wound of blood or other fluid which cannot escape, the treatment being the simple provision of drainage, which, however, must be done by a physician. Sapremia, a form of blood-poisoning due to the presence of poisonous products (toxins) developed in the putrefaction of a wound (some wounds).
Septicemia, a form of blood-poisoning due to microorganisms and their toxins and the toxins of putrefactive tissue in the blood. Pyemia, the presence of pus in the blood, there being developed foci of suppuration, shown by multiple abscesses, phlebitis and similar conditions. Radical eliminative measures are neces¬sary in these cases, including the withholding of all food, copious water-drinking, large and frequent enemas and the cleansing of the wound. A doctor should be called immedi¬ately upon the appearance of any suggestion of infection in a wound, but eliminative treatment should be instituted at once.
Sealing of Wounds. Surgeons classify healing of wounds: by first intention, immediate union or healing of the surfaces without suppuration or formation of granulations; by second intention, union by granulation of the two surfaces, accom- panied by more or less suppuration; by third intention, when the wound cavity or ulcer is filled with granulations and perhaps considerable suppuration, with later scar-formation upon complete healing. Sometimes healing under a scab is classed as a special variety; it may take place by first or by second intention.
But in all cases, whether by first, second or third intention, the method of healing is fundamentally the same. Some degree of inflammation is excited, which aids in the formation of new material which fills up the wound. The chief new material is a form of connective tissue known as scar-tissue. New blood-vessels penetrate this new tissue, forming from the severed blood-vessels. Eventually circu¬lation is restored. Collateral circulation supplies a great deal of the circulation of a part in more severe wounds and when considerable scar tissue is formed.
The surface of the wound is covered with epithelium which grows from the cells of the severed skin. The inflammation is a natural process, incited by the injury, but infection will increase the inflammation beyond the normal reparative degree, producing suppuration and interfering with healing.
VOMITING.—This symptom may be due to one of several causes, such as indigestion, nervousness, irritant food, sick headache, pregnancy, cancer of the stomach, ulcer of stomach or duodenum, strictures or obstructions in the food tube, dila¬tation of the stomach, poisoning, drugs, kidney disease, brain disease, acute appendicitis, seasickness, car-sickness, the onset of acute disease, and so on. Usually it is best not to attempt to check the vomiting, though if the stomach is empty and the patient exhausted or weak, or if there is a condition in which the strain of vomiting is dangerous, the passive measure of keeping all fluids out of the stomach may help hold it in check. Ordinarily the vomiting will cease when the stomach is cleared of the irritant, whatever it may be. Any case that continues after the stomach should have been emptied should be in the care of a physician.
Sometimes the trouble may be brought to an end quickly by encouraging vomiting (see Emetics). This should be done in all cases of vomiting due to indigestion and poisoning (see Poisoning). When the patient has frequent and exhausting vomiting and knows from previous examinations that there is nothing cdntraindicative, the vomiting may safely be allayed by rest and fasting, by fomentations or a mustard poultice over the stomach, by sucking small pieces of ice or sipping iced lemonade, or by lavage, or perhaps by warm or fairly hot enemas or rectal irrigations.
WASPS., STINGS OF.—See Stings and Insect Bites. WHISKEY AS STIMULANT.—See Alcohol and Stimulants. WOUNDS.—In order to understand the action of the blood in case of wounds it will be well for the reader to study the circulatory system and the blood in Volume I. In the study of anatomy and physiology one finds that the blood contains countless corpuscles, both red and white; that in case of in¬jury the latter throng to the seat of trouble and attempt to overwhelm any germs or sources of infection, for they are the body’s defenders; and that pus consists of innumerable deador crippled white blood cells, germs and the debris of the fight. One also finds that when the blood is exposed to the air, or comes in contact with injured tissues, it changes its form, producing clots, or coagulums.
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The treatment, naturally, will depend somewhat upon the causing condition, but some general rules will apply in most cases, such as those regarding restoration of breathing and warmth of the body. All that can be accomplished by drug stimulation in cases of unconsciousness or suspended anima¬tion can be brought about by natural measures in a manner equally effective and without the dangerous reaction or de¬pression which follows the former.
The most energetic vital stimulants are to be found in hot applications over the heart and in alternate hot and cold applications to the spine. Con¬gestion of any part should be overcome as quickly as possible without too vigorous measures and the general circulation should be aroused to a more normal degree except, usually, in brain injuries (including apoplexy) and hemorrhage.
When the hands and the feet are cold, hot applications should be made to these parts, in addition to any general cir¬culatory stimulation, and should be combined with active rub¬bing of the limbs. Dashing cold water over the face and the chest, particularly the latter, helps to excite the respiratory function and to restore breathing, but should not be used in the two conditions mentioned just above. If the face is flushed and hot, cold compresses or affusions to the head may usually be used safely.
If the face is pale, hot applications over the heart, also alternate hot and cold applications to the spine, may be used. High fever calls for cold water sprinkled or poured over the body, or over sheets wrapped about the body. Friction to the body, with heat to the extremities, is of considerable value in the majority of cases. In all cases, be¬fore anything else is done for the patient, loosen all constrict¬ing clothing about throat, chest and waist.
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A test for unconsciousness is found in raising the eyelid and touching the white of the eyeball. If the patient is un¬conscious, no movement will be noted, whereas if he is con¬scious but shamming, or in an hysterical spell, he will be un¬able to avoid blinking.
If the eyes are sensitive to touch and light, there is no brain injury. If the pupils are unequally dilated there is brain trouble. If the pupils are equally contracted to pin-points, there is poisoning by opium or one of its derivatives.
One should note the color of an unconscious person’s face, whether pale, flushed, or purplish. Note the odor of the breath, for such poisons as alcohol, chloroform and opium may be readily detected. If there is blood on the lips or mouth corners, it may be due to skull fracture or to the bitten tongue in an epileptic seizure.
Place the patient on his back and turn his head to one side so the tongue will not fall back into the throat to embarrass breathing and so any vomited matter may not enter the tra¬chea. If the face is flushed the head may be slightly raised, but if it is pale the head should be laid flat. If the face is bloated and flushed, excessive alcoholic indulgence is indi¬cated. If it is drawn to one side, apoplexy or brain compres¬sion is indicated.
Very slow breathing indicates weakness or shock. Snor¬ing or stertorous breathing indicates coma, collapse, narcotic poisoning or brain trouble. A slow pulse denotes coma or brain trouble. Rapid pulse indicates sunstroke or fever. If the pulse is quick and thready, there is shock, collapse or great weakness (prostration). If the skin is hot and dry, there is sunstroke or high fever. If the skin is cold, there may be freezing, fainting or intoxication collapse.
UNCONSCIOUSNESS.—Unconsciousness is an alarming symp-. torn which ranks next to hemorrhage in its effect upon observ¬ers. If something is known of the preceding conditions the diagnosis is not difficult. Unconsciousness in a woman com¬ing on during excitement points to fainting; unconsciousness in one working or strenuously exercising in the sun points to sunstroke; in one who has been the victim of a fall, brain con¬cussion or skull fracture; in one with a history of kidney disease, uremia; or with a history of diabetes, a diabetic coma; or with a history of heart disease, “heart attack”; in an elderly person after a meal or after exertion or excitement, apoplexy.
Suspended; Apo¬plexy; Asphyxia; Brain, Compression of; Brain, Concussion of; Catalepsy; Coma; Convulsions; Drowning; Electric Shock, under Burns and Scalds; Epilepsy; Fainting; Freez¬ing; Heat Exhaustion; Hemorrhage; Hysteria; Neck, Broken; Paralysis; Poisoning; Skull Fractures, under Fractures; Sleep Produced by Poisons; Strangulation; and Sun¬stroke.
But one may not have time to look through all these refer¬ences in case of unconsciousness in another to whom one must give First Aid. However, it should be remembered that if one attempts to do much for the patient there is the possibility that some measure of harm will result through using a treatment not indicated. Hence if one cannot determine something of the nature of the cause of the unconsciousness, it will often be better to await the arrival of the doctor, who should be called immediately upon finding a person in an unconscious condition.
TOOTHACHE.—A dentist, when his services are available, should determine the cause of a toothache. But it sometimes happens that a person will be out of touch with one and cannot reach him for several days, in which case something must be done to relieve the suffering. Many men swear by tobacco for this purpose, and there is no doubt that a small quid pressed into a tooth cavity will relieve the distress. This has more effect on one who is not an habitual user of tobacco than on those habituated to it, but in the case of the former the cure is sometimes only slightly less uncomfortable than the disease.
If available, oil of cloves saturating a tuft of cotton pressed into the cavity is a better and more agreeable remedy. A fig heated in boiling or very hot water until it is as hot as the mouth membranes can endure, split and put over the offending tooth is a good means of securing relief. A hot-water bottle or other heat applied externally will often prove effective. If the tooth feels too long each time the opposing teeth strike it there is an abscess which, if possible, should be treated by a dentist without delay.
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