Plain directions for the treatment of wounds in general: With methods of stopping violent bleedings in cases of large wounds ... to which are added remarks on suspended animation, ... By Bernard Ogden, ...

WOUNDS.

On the use of the Tourniquet or Bandage, and manner of stepping violent Bleedings.

IN treating of the management of wounds the first thing that demands our consideration is the bleeding with which most of them are attended. When the blood is not poured out with great force, though the quantity should even be considerable, it generally proceeds from wounded veins, and may be stopped by pressing a piece of scraped lint, either alone or dipped in fine flour or Turlington's Balsam, upon the wound with the fingers. But when the Hood is thrown out with great force, and especially if it springs out by jerks, it proceeds from wounded artcries, and requires the most serious attention.

To direct us in this case, we must consider the arteries as strong branched pipes or tubes through which the blood is forced from the heart at each beat to every part of the trunk of the body, to the head, to the arms, and to the legs.— The veins spring in small branches from all the parts the arteries carry blood to; they pursue their course towards the heart; joining with each other, forming gradually larger and larger veins, till they reach the heart in one large trunk. The heart may be compared to a sort of forcing pump, throwing the blood along the arteries with such force, that we can feel the jerk or pulse wherever an artery lies: and the blood losing its impulse as it passes along, makes its way, without any pulse or beating, into the veins, through which it returns to the heart, compleating what is called the circulation of the Hood.

From these simple principles the method of putting a stop to a bleeding from a wounded artery is exceedingly plain; that is, it must be compressed between the heart and the wound.

In wounds of the foot or leg the bleeding may be stopped by casting a knot in the middle of a handkerchief, placing the knot in the ham or hollow behind the knee, tying it tight before, and twitching it sufficiently by means of a stick, put between the place where we tye it and the thigh. The handkerchief should be tightened as quickly as p••ssible after it is put on, otherwise the veins will be painfully stretched. For a very slight pressure on a vein stops the course of the blood in its return to the heart, whilst the artery requiring more force to obstruct it, keeps throwing blood into the veins of the limb, distending them as when we tye an arm up for bleeding.

When the wound is in any part of the thigh a handker∣chief must be firmly knoted round the limb, between the place of the wound and the body; and must be twitched with a stick as before directed. But should the wound be so high up as to leave no room for tying the handkerchief above it, a firm pressure must be made, with the hand, on that part of the groin where the watch lies when the wound is of the right thigh, and on the left groin when the wound is of the left thigh.

If an artery in the hand or arm is pouring out blood, we stop it by casting a knot in a handkerchief, placing the knot on any part of that side of the arm which is next the body between the elbow and armpit, tying it round, and twitch∣ing it with a stick as in wounds of the leg. And here it must be observed, that in dangerous bleedings, from wounds of the limbs, there is neither time nor necessity for stripping the part we apply the ligature to; for there is no doubt of lives having been lost by attempts to undress the limb when an expeditious appheation of the handkerchief above the cloaths, but higher up than the wound, might have saved them.

In wounds of the head or trunk of the body we command the bleeding by pressing firmly with our singers on that border of the wound the blood springs from; and when we cannot determine which side the blood comes from, we press one side after another till we succeed.

By these means, which it is every man's duty to be ac∣quainted with, the most violent bleeding may be stopped for

some time; and where a surgeon can be had no more should be attempted. But when it unfortunately happens that the wound is received at sea, or where no surgical assistance can be obtained, a manly resolution must be put on to save the sufferer's life, which it is hoped the following directions will assist.

A temporary stop being put to the bleeding by one or other of the forementioned methods, the wound should be cleared of clotted blood, or whatever else may happen to stick to it, by washing it gently with a sponge and milk∣warm water. It should next be dried, and the pressure re∣moved from the artery, by raising the finger, in cases of wounds of the head or body, and by untwisting the stick of the handkerchief or tourniquet in wounds of the limbs, in order that the flow of blood may direct us to the mouth of the wounded artery. We now take notice of the place the blood springs from, and immediately renew the pressure by the fingers or twitch; and by again washing the sore en∣deavour to find the opening, which will seldom be difficult when the wound is large and open, and the artery of any consequence. If the blood proceeds from a wound in the side of an artery, the wounded part of it may be raised up by means of a large needle, so as to allow a piece of double waxed thread to be passed under it on the side next the heart, and firmly tied round the artery, taking care to leave the ends of the thread so long as to hang quite out of the wound.—The same should be done on the other end of the opening if the artery is large. But when an artery is quite cut in two, the ends soon shrink amongst the flesh, so that the bleeding is sometimes stopped in both of them; almost always in that most distant from the heart; for then no blood passes into it but by small branches between it and the other arteries of the limb.

For the most part, however, the upper end in large arteries, continues to throw out dangerous quantities of blood, which we must endeavour to stop by drawing it out with a needle, and tying it firmly with a double waxed thread.

When the end of a limb is carried away by a cannon ball the bleeding is seldom very alarming, for even large arteries are, in that case, closed up by the bruised parts. But we

should not entirely depend upon this, as the larger ones gene∣rally break out again in a short time when we are not aware of it, and so prove fatal. We are, therefore, to put the twitch round the limb, but without tighteaing it, to wash away the clotted blood with a sponge and warm water, in order to discover the end of the artery, that it may be tied as before directed.

This method of securing wounded arteries is certainly the safest and best when it can be followed; but cases may occur where, either from want of courage, or of dexterity, it does not answer; in these recourse must be had to the following:

Having discovered, by the means already described, the mouth of the bleeding artery, or at least the part of the wound in which it is situated, we press a piece of sponge of a convenient size firmly upon it; over this we lay a piece of scraped lint, folded up and dipped in Turlington's Balsam, and then some pieces of linen rag, folded up as if for bleed∣ing, each a little larger than that laid on before it, till a pile is raised an inch or two above the edges of the wound according to the size of the wound; binding the whole firmly down with a bandage of linen about three inches broad, and so long as to cover the limb with two or three plies, extending at least four inches each way from the wound.

The sufferer must now be laid in bed, in such a manner that the wounded part may lie easy and undisturbed, and not too much covered with bedeloaths. Nor where the wounded artery is large must the handkerchief be removed from the upper part of the limb for three or four days; nor must the patient be left alone during that period for any length of time, since startings of the part, or many other causes, may give rise to repeated bleedings, which might be prevented from proving fatal by immediately tightening the handkerchief or tourniquet. In this state the wound must remain for the space of four or five days, or until the dressings are loosened by the formation of matter, when it must be managed in the same manner as other wounds with loss of substance, which we shall fully describe under the next head.

TREATMENT OF WOUNDS.

HITHERTO we have confined ourselves to the means of stopping the discharge of blood from wounded arteries, we are next to consider the most proper mode of dressing every variety of wounds; and for the sake of method begin with those most easy of cure.

Of this kind are clean flesh-wounds running in the direc∣tion of the limbs on which they are situated; for here we can avail ourselves of the disposition which the edges of such wounds have to grow together when they touch each other constantly, by what is called adhesive inflammation, and by which the healing of a considerable wound will sometimes be effected in three or four days, so as to require no farther care than avoiding such accidents as might tear it open again before the part regains its strength.

In every clean wound therefore where there is no bleeding artery, or where we have been able to tye it, as this method is admissible recourse should be had to it. The first thing to be done is to make the wound as clean as possible by means of a sponge and warm water; and having absorbed as much as we can of the blood from its surface, the surrounding skin must be dried with a cloth, and whilst another person holds the edges of the wound nicely and closely together with his fingers, but so as to be out of our way, strips of sticking plaister, from three to six inches in length, and from a quarter to half an inch in breadth, are to be laid right across the wound, a straw's breadth distant from each other; warming them as they are applied, to make them stick more readily, and carefully drying the skin wherever the least moisture appears.

If an artery has been tied in the wound the ends of the thread must he brought out at that edge they are nearest to, and should be left of such a length as to reach an inch beyond it, when the wound must be closed, and the strips of plaister applied as before. And here it may be useful to observe that the person who assists us should lay his singers on the strips as we proceed to secure them more effectually. The

tract of the wound must now be covered with a piece of seraped lint, and over this we must lay a piece of the same thinly spread with cerate, and so large as to reach half an inch in every direction beyond the first piece. And lastly, this dressing must be secured by binding the part neatly up with a linen bandage, reaching a hand's-breadth each way from the wound. The wound being thus dressed it must be kept quite easy and unmoved till the fourth day, when the bandage must be cantiously unfolded, softening it with a sponge and warm water if it is glued together with the blood. The lint must be next removed, and if there are threads hanging out from tied arteries they may be very gently drawn; but if they are not disposed to come away easily they must not be forced, but tried at each fature dressing till they are quite loose. After examining the threads, the sticking plaisters must be removed; and having gently wiped away any matter that may be found on the sore, or on the adjoining skin, they may be renewed but in less number, and also the lint, the lint spread with cerate, and the handage. This mode of dressing must be repeated daily, and continued so long as the threads remain, any matter appears on the wound, or its edges continue tender; but when these appearances cease, allowing the same dressing to remain, a few days will com∣plete the cure.

We have dwelt particularly on this mode of curing wounds, as it is the most satisfactory in its consequences, the most desirable when ever it can be used, and may serve as a model for some part of the treatment of the description of wounds we are next to consider.

Wherever there is a loss of substance in wounds, or where there is such a vacancy left between the sides of the wound, by the shrinking of the divided skin and flesh, as renders it impossible to keep them together by strips of sticking plaister or bandages, a disserent and much more tedious method of cure alone remains for us. A bruised or ragged wound, or one we have been obliged to sill with scraped lint, sponge, &c. for restraining the discharge of blood must be treated exactly in the same manner.

The process which nature follows in the repair of these injuries is admirable, and must be attended to before we can manage the treatment of them.

The first thing observable in wounds whose edges are lest open is, that the surface of the wound is in every instance thrown off by the formation of matter under it. Sometimes this surface is so thin as almost to escape no∣tice; at others thick, and is then called a slough or sit∣fast. And where much violence has been done to the structure of the part by a bruise, or where the habit of body is faulty, the slough is sometimes of a very serious size as happens in cases of gangrene. The colour of sloughs varies with their degree of importance; the slight ones, when they are not tinged with blood, are of a buff dolour; the more serious ones are ash coloured, mixed here and there with black, brown, green, and yellow. No sooner are these sloughs discharged than the matter becomes cream∣coloured and thick; the surface of the fore looks red and clean; the cavity of the wound gradually fills up with tender granulations, or now flesh, to the level of the adjoining skin; and lastly, a thin rind begins to form round the edges, which extending inwards, becomes the future skin.

Having taken this slight view of the healing process, in wounds whose edges are left open, we are prepared to enter upon their treatment. Clean wounds of this kind must be filled lightly with scraped lint; ragged or bruised ones with the same dipped in Turlington's Balsam. Over this a pledgit of basilicon, spread upon sine tow, must be laid, and then a nice bolster of tow, binding the whole on with a ban∣dage. In this state the part must remain till the fourth day, when the matter generally loosens the dressings so as to make their removal easy. At this time we take away all that is loose, or can be rendered so by moistening with warm milk and water; but clip off the ends of those pieces of lint that still stick to the sore. We lay on a little fresh lint, renew the plaister, bolster of tow and bandage, and change this dressing daily, gently wiping the edges of the sore with a piece of tow, to remove any superfluous matter, and taking care not to cram it with the lint. And when the cavity is filled up we must change the basilicon pledgit for one of

cerate, covering the surface with a single piece of lint rather larger than the sore, and laid with its softest side downwards, still dressing once a-day till the cure is complete.

When a wound is attended with a high degree of inflam∣mation and swelling, or its edges are hard and projecting, white bread poultices must be applied once or twice a day above the pledgit instead of the bolster and bandage, and in that case the patient may take a cooling purge, such as salts.

But when, on the other band, the surface of the skin around the sore looks flabby and soft, is covered with blisters, or the sloughs are thick and ill coloured, the discharge thin, dark, and very offensive to the smell, the bark must be given freely in the manner directed under that article in the di∣rections. Towards the conclusion of the cure of sores the new granulations sometimes rise above the surface of the sound skin, forming what is called fungous, or proud flesh, this may be kept down by touching it occasionally with a piece of wetted blue vitriol, which will in such a case amazingly hasten the healing.

Balls, splinters of wood, bone, or glass, pieces of the cloaths, or any kind of extraneous substance found in a wound, must be immediately removed if that can be done by gentle means, as they for the most part absolutely prevent the cure, and are often productive of distressing and dangerous con∣sequences. But where their removal is difficult they must be suffered to remain till they are loosened by the digestion of the wound, or till the case comes under the management of a skilful surgeon, whose assistance these few directions are never designed to supersede.

SCALDS AND BURNS.

SLIGHT scalds may be smeared three or four times a-day with a mixture of three spoonfuls of olive oil, one o∣cerate, and thirty drops of Goulard's Extract, and covered with a piece of soft rag moistened with the same. If a few small blisters should rise do not disturb them for a day or two, when the pain and inflammation will probably be

gone, they may then be discharged by snipping them in places with a pair of scissars, and the sore must afterwards be dressed with cerate only.

For more violent scalds where the skin comes off directly, or where very large blisters are raised at first, as happens when boiling water is long applied to the part, or where they are occasioned by hot grease or oil, the blisters may be cut immediately, and the part dressed with equal parts of basilicon and cerate, spread on linen rag, once or twice a-day according to the quantity of the discharge.

Violent burns always destroy the texture of the part to some depth; in this case they must be treated in the same manner as wounds with the loss of substance, as described at page 11.