Saturday, 10 September 2016

15 January 1881 - 'Some Useful Hints on Surgery' by Medicus

When I was a little boy at my first school the Bible was one of our text-books. It was the first history ever I had read, and I was naturally much interested in its heroes and heroines. David, I know, seemed to my mind just the beau-ideal of all a boy should be, and when I read of the brave and undaunted manner in which he attacked and slew Goliath, I determined to emulate him, at least, so far as the sling and the stone went, and I succeeded so well that in three weeks after I first commenced practice, I smashed my poor sister's arm. Of course, I was not aiming at Nellie, and the greater the pity, because I never did hit anything that I aimed at. On this particular occasion I was aiming at a farmer's ox in a distant field; this was very wicked, but when I saw Nellie drop down and faint with the pain, I thought she was dead, and wrung my hands and wept aloud and danced frantically around her. This probably relieved my own feelings, but it could not have done Nellie much good, and had I known then only a very little of what I know now, I would have acted differently. But what *I did then is just precisely what nine out of every ten young people do daily, when an accident occurs to a brother, sister, or playmate. To render assistance promptly hardly ever occurs to them.

"Oh! But," some of my readers may exclaim, "we don't know what to do in cases of emergency."

You are quite right; and therefore I am going to tell you in this paper and in the next what is the best and safest way to deal with little accidents, and I am quite sure you will listen to what I have to say with pleasure and derive some profit therefrom as well.

Now the most alarming of all little accidents, in the eyes of young folks, are those that are accompanied by the effusion of blood, so I will take them first. The simplest of these is bleeding at the nose. Sometimes, in the case of stout, rosy-faced children, this is salutary, but it proves that they are making blood too quickly, that they are in reality not strong, so the general health should be seen to, and plenty of exercise taken. As to medicine, laxatives should be given and some simple tonic. When bleeding at the nose occurs from a blow, or if it be excessive from whatever cause, means must be taken to stop it. The sufferer must not remain in a warm room; going out into the cool fresh air will often of itself suffice to stop the bleeding. If it does not, then the nose and brow ought to be bathed in the coldest water procurable. The upright position should be maintained, the head thrown well back, the arms raised, and either ice or a cold piece of iron or steel applied to the spine.

Cuts or wounds, as a rule, require very simple treatment. First and foremost, do not be alarmed at the sight of a little blood; there is no danger, unless it be of a very bright red colour and spurts out in jets; that would show that an artery has been cut; but even then you must not give way to fear. All you have to do is apply pressure on the wound by means of your thumbs, and send for a medical man or surgeon. If a simple cut or wound is torn and lacerated, it must be washed with cold water and a bit of sponge before it is done up, and if any dirt or foreign matter such as sand or glass be seen in it, that must be very carefully removed; then cut two or three pieces of sticking plaster, about as long as your little finger, and no wider, heat them one by one before the fire, and one by one apply them over the wound, just to keep the edges gently together. After you have applied one, you must not put the next close to it; you have to leave room between every piece, for any matter that may form, too afterwards find vent. Apply over this a little lint, made by stretching a piece of old, cleanly washed linen tight, and scraping it with a knife; over all a bandage must be put, and you must keep a wound like this clean, but do not disturb the dressing room more than is actually required. If it seems angry, a bit of clean surgeon's lint dipped in water, with a piece of oiled silk over it, makes a very soothing dressing. A simple even cut may be bound up with the blood, which, by keeping the air from it, hermetically seals it, and it will heal thus without further trouble.

A bitten tongue often bleeds profusely, and gives a great pain. Wash the mouth with the coldest water, in which some powdered alum has been mixed, and continue doing so until the bleeding stops.

When the skin has been torn off or grazed off any part of the hands, arms, or legs, the bleeding is sometimes difficult to stop. Cold water may be sufficient to do this, if not, tincture of iron should be applied. This tincture of iron is the same tonic (called steel drops) which I so often recommend pale and delicate girls to use, in the proportion of ten to fifteen drops three times a day in a little cold water. So you see it is a handy thing to have in the house for more reasons than one. Scalp-wounds, or wounds in the head, require somewhat different treatment. If in the forehead, the usual sticking plaster dressing and a bandage will suffice to mend matters; if in the scalp among the hair, the latter must be cut off all around the wound to admit of the application of the plaster; the bleeding in either case must be stopped by pressure, cold water or ice.

The youngest of my readers should know how to treat simple scalds and burns, for, small though they may be, they are exceedingly painful, and it is a gaining of half the battle if you can give relief. A burn or scald in the hands, or wrist, or fingers, if the skin be not blistered or broken, is relieved in a surprisingly short time by the application of a rag or morsel of lint wetted in turpentine. Soap applied to a slight burn is likewise a good application to remove pain. Water-dressing is also effective, and after the pain has been removed, the place may be dressed with simple ointment, cold cream, or glycerine. Another excellent application to a burned surface is what is called "carron oil," it is composed of equal parts lime water and olive oil, with a small quantity of turpentine. In all cases of severe burning medical aid should be summoned as soon as possible.

If a child's clothes catch fire, she ought to be thrown down at once, and a heart-rug, blanket, or whatever comes handiest, rolled around her to extinguish the flames. When anyone has the misfortune to catch fire, she ought at once to throw herself on the floor and roll about; if this plan be resorted to, the fire cannot spread upwards over the head, and life may be saved, to say nothing of terrible deformity.

Children sometimes swallow boiling water, from a kettle for instance. In a case of this kind all you can do is to keep the sufferer perfectly quiet, and give him ice to suck if you can procure any, and meanwhile send at once for a surgeon.

Bruises are the result of direct violence; in these cases, although no bones are broken and the skin is left intact, the small veins in the flesh are lacerated and blood thrown out under the skin, discolouration being the result. A black-eye is one of the simplest examples of a bruise, and probably one of the commonest; a blow on the forehead from running against something hard is another; and both, simple though I call them, are very disfiguring especially in a young girl. When, then, anyone receives a blow which she is afraid may lead to discolouration of the skin, either arnica lotion or spirit lotion should be applied immediately and constantly for some considerable time. The arnica lotion is easily made; it is simply a tablespoonful of tincture of arnica in a small tumblerful of water; it is a useful application to sprains as well. Vinegar and water is also a very cooling lotion, in the proportion of one part of the former to three of the latter.

A jammed finger is a most painful accident. Steeping the finger in very hot water is the most effectual method of giving relief. I may mention here that an incipient whitlow may sometimes be dispersed in the same way, provided matter has not already formed; but when once this begins to burrow under the tendons poultices and free lancing will bring the first relief.

A blister of the skin, whether in the foot or hand, seems a very simple thing indeed. Yet nine persons out of every ten do not know how properly to treat it. It may be caused by friction of any kind - friction from a tight or too loose fitting shoe, or friction of the hand from rowing, drilling, or using tools of any kind. The first thing to do is to pass a needle with a loose cotton thread through it. Cut off this thread at each side of the blister, and thus allow the water to run or drain out of the bleb; it will afterwards heal up nicely, but rest must be given. Now I do not know that any young lady wants to harden her hands, even  for the sake of drilling; for a soft hand is certainly a point of beauty in a girl. But if, notwithstanding this, she objects to have hands easily blistered let her bathe them morning and night for ten minutes in a quart of soft spring water, in which a little toilet vinegar and a teaspoonful of alum have been mixed. This bath also does good in cases of clammy hands; but, mind you, I am not putting it forward as a specific, either for clamminess or blisters, but I do happen to know that it often does good.

Blisters, or blebs, that contain blood may occur on the legs or arms; they are not due to friction, but on the other hand, they point to a vitiated state of the blood, and the remedies for them should be internal or constitutional ones. The blood is impoverished, and the steel-drop tonic will do good. Plenty of milk is almost a certain remedy, but it must be new milk and, if possible, drunk fresh and warm from the cow. Exercise in the open air will provoke an appetite and enable the girl who suffers from these signs of impoverished blood to eat well and heartily, which is exactly what nature displays those blisters to entice her to do. They are to be looked upon as small flags of distress.

Boils are also a sign of impure and impoverished blood. Some girls constantly suffer from them, crop after crop appearing and causing great distress, because they are not only disfiguring, especially if in the face, but very painful as well. These boils also point to a state of the blood which sadly needs reform; indeed, the general health of girls who suffer in this way is at a very low ebb. Everything, then, should be done that tends to increase the strength and purify the blood. Simple laxatives, such as cream of tartar or Gregory's powder, should be taken twice or thrice a week. The digestion should be carefully attended to, nothing being eaten that is in the least likely to disagree, and not too much of anything eaten at one time. Exercise in the open air should be abundant, but not fatiguing, and the soap bath taken nearly every day. (I have already described the method of taking the bath in THE GIRL'S OWN PAPER.) Tonic medicines should be taken also, say a teaspoonful or more of quinine wine three times a day, and ten drops of the tincture of iron.

Touching the little boils three or four times a day with a drop or two of Goulard water, and suffering it to dry on, may tend to keep them back, or hot water may be tried.

A style is simply a small painful boil on the eyelid; it should be bathed three or four times a day with warm milk and water, and a poultice applied at night. As soon as it points, great relief will be gained by pricking it with a fine but perfectly new sewing needle.

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