Copyright
Charles Field Mason.

A complete handbook for the sanitary troops of the U. S. army and navy and national guard and naval militia online

. (page 8 of 38)
Online LibraryCharles Field MasonA complete handbook for the sanitary troops of the U. S. army and navy and national guard and naval militia → online text (page 8 of 38)
Font size
QR-code for this ebook


ONE of the most important of the many duties of the hospital-
corps man is to render first aid ; in time of war it becomes his most
important duty. In order that this duty shall be performed promptly
and efficiently and without excitement or hesitation he must be taught
what to do until he possesses the confidence born of knowledge.

If called upon for assistance in an emergency under other con-
ditions than those of an action his first duty is to send word to a
medical officer; in action this often can not be done. The next step
is to see that the sick orjnjured man is not crowded about so that
he can not get air; then the nature of the case must be ascertained as
quickly as possible. Look for bleeding; if it is at all profuse it
must be stopped at once; if there is shock lower the head and give
a little aromatic spirits of ammonia in water; if there is a wound
protect it by a first-aid dressing, ripping up the clothing if necessary
to get at it, but not attempting to clean or handle it in any way; if
there is a fracture immobilize it before moving the patient a foot, so
that a simple fracture may not be made compound. Then remove
any equipments the soldier may have on, unbutton his collar, and
loosen the clothing about his chest and abdomen.

In action the amount of first aid to be rendered will depend on
circumstances; perhaps the arrest of severe hemorrhage is all that
can be attempted.

The clothing must be preserved as far as possible, for it is often
impossible to replace it. On reaching the hospital the clothing must
be very gently removed. To remove a shirt, pull it up from the back,

(89)



90 FIRST AID

then draw it over the head to the front, and lastly disengage the
arms; if one arm is injured disengage the well arm first, then draw
the shirt over the head, and lastly free the injured arm; if necessary
rip up the seam on the injured side.

A contusion or bruise is a subcutaneous or closed wound : a lacer-
ation of the deeper tissues without a division of the skin. Contusions
vary in extent from an ordinary " black and blue " spot, to the almost
complete purification of a limb with laceration of the blood-vessels
and nerves such as sometimes occurs in railway or other accidents.
The first evidence of contusion is usually rapid swelling of the part;
every one knows that when one is struck a hard blow on the eye the
swelling closes it almost immediately, or a blow on the head is
promptly followed by a " bump." There is only one thing which
could cause such rapid swelling, and that is bleeding caused by the
laceration of the subcutaneous tissues and vessels, the blood not
being able to escape. At first there is no discoloration, but after a
few hours or a day, the blood makes its way toward the surface,
and the part looks black and blue and, as changes later take place in
the blood, greenish or yellow. Another symptom is pain. If the
injury is severe there is shock ; the more shock the less pain usually.
Shock is a condition of nervous depression like fainting, only shock
is due to physical causes, while fainting is due to mental impressions.
The symptoms of shock are anxiety, pallor, dilated pupils, trembling,
chilly feeling, nausea, clammy skin, very weak pulse, sighing respira-
tion, often a subnormal temperature. The amount of shock will
depend upon the part of the body injured and the gravity of the in-
jury; it is much more marked in injuries of the trunk than in in-
juries of the extremities ; injuries of the testicle are apt to be attended
with marked shock. Shock may be so severe as to terminate fatally
without reaction.

The treatment of shock consists in the use of heat externally and
stimulants internally, hemorrhage must be carefully looked for and
controlled if present. In severe shock on the field it is often safer
not to attempt to move the patient until there are signs of reaction ;
give him some stimulant and leave him temporarily. If he can be
moved get him in bed as quickly as possible ; wrap him in hot blankets
and surround him with bottles of hot water; give him hot coffee or
hot beef tea ; keep him perfectly quiet with the head low.

For the treatment of the contusion itself the indication is to stop



EMERGENCIES, CONTUSIONS AND WOUNDS 91

the subcutaneous bleeding ; this can be done by very hot or very cold
applications ; if the injury is in a limb, firm, even pressure of a band-
age may be effective. Later when the bleeding has ceased the ab-
sorption of the extravasated blood may be hastened by hot fomen-
tations and massage.

A wound is a division not only of the tissues but of the overlying
skin. Wounds are classed as incised, lacerated, contused, punctured,
and poisoned; gunshot wounds are usually considered in a class by
themselves.

An incised wound is one made with a sharp cutting instrument,
the class of wounds commonly known as cuts, such as cuts with a
razor or knife.

A lacerated wound is a torn wound, such as is made by barbed
wire or a piece of shell ; it does not differ practically from a contused
or bruised wound made with a blunt instrument such as a club or
stick.

A punctured wound is deep and narrow; stabs are punctured
wounds.

A poisoned wound is one in which some poison has been intro-
duced by the same agent which made the wound; any of the above-
named classes of wounds may be poisoned.

Gunshot wounds are both punctured and contused; they may also
be lacerated.

Incised wounds are especially apt to be attended by bleeding;
lacerated and contused wounds are less apt to give rise to dangerous
hemorrhage because the vessels are torn and twisted; a limb may
even be entirely torn off without serious bleeding, but shock in this
class of wounds is apt to be severe.

Punctured wounds are dangerous because, while the external
opening may be small, they often penetrate so deeply as to seriously
injure important organs, or cause internal hemorrhage.

The immediate dangers of wounds are hemorrhage and shock; if
these are removed the one great danger is infection; if that can be
prevented the most serious wounds may be recovered from unless of
course there is irreparable injury to some important organ.

The healing of wounds takes place in two ways; if there is no in-
fection and no loss of tissue and the parts are brought into proper
apposition healing occurs by first intention; otherwise by granulation
with or without suppuration.



92 FIRST AID

Most incised and small-arm bullet wounds are originally aseptic,
or germ free, and if kept so will heal or grow together under one
dressing, without heat, redness, severe pain or swelling, and without
fever. The bullet itself after it has lodged is usually harmless and
may be ignored as far as the treatment is concerned.

If the wound becomes infected with pus cocci, inflammation occurs
with its attendant symptoms of heat, redness, pain and swelling, and
usually more or less fever ; suppuration follows, and if the pus can-
not escape freely some of the poisons produced by the growth of the
pus cocci are absorbed, septic toxemia, or the cocci themselves get
into the blood-vessels, septic infection; the septic infection may
result in the formation of abscesses in the different parts of the body,
pyemia. All these blood poisonings are attended by chills, or chilly
feelings, fever, headache, a peculiar waxy appearance of the skin,
and perhaps delirium and stupor. Unless arrested the process
terminates in death.

Recent war experience, with its constant trench fighting, has
shown that under the new conditions many wounds, especially those
caused by shrapnel, shell, and hand grenades, are primarily infected,
and not only with the bacteria of suppuration but often with those
of gas-gangrene and tetanus. If infected with the germs of gas-
gangrene, the wound quickly becomes foul and sloughy, and full of
gas, so that it crackles under pressure.

The first-aid. treatment of wounds consists in the arrest of hem-
orrhage and by hemorrhage must be understood serious bleeding,
and not the moderate bleeding which accompanies most wounds and
only requires the pressure of a dressing the relief of shock and
the prevention of infection.

To prevent infection is all-important and may be accomplished
by following a few simple rules : do not touch the wound with the
fingers or anything else; do not attempt to wash it or remove
particles of dirt or clothing; if the intestine is protruding do not
attempt to replace it ; if the sharp end of a broken bone is sticking
through leave it undisturbed ; remove the soiled and bloody clothing
about the wound, paint the wound and surrounding skin with tincture
of iodine, allow it to dry, and apply the contents of the first-aid
packet, handling the gauze with the waxed paper so as if possible
not to touch any part of the dressing with the fingers.

Each soldier in the field is issued a first-aid packet for his in-



EMERGENCIES, CONTUSIONS AND WOUNDS 93

dividual use ; it has a hermetically sealed metal cover, and contains
two compresses of absorbent sublimated gauze, each sewed to the
center of a sublimated-gauze bandage, each bandage being wrapped
in parchment or waxed paper and two safety pins wrapped in waxed
paper.

The first-aid packet is carried by all officers and enlisted men.

To protect the extensive wounds often caused by shell fire the
ordinary first-aid packet is not large enough, so that these packets
are now supplied in two sizes.

The larger or " shell-wound dressing " is wrapped in tough paper
with directions for application printed thereon, and each contains
i square yard of absorbent sublimated (1:1,000) gauze so folded
as to make a pad six by nine inches, stitched to the back of each end
of this compress is a piece of gauze bandage three inches wide by
forty-eight inches long. The dressing also contains one absorbent
sublimated-gauze bandage three inches wide by five yards long, and
two safety pins.

If a first-aid packet is not at hand, the dressing may be of ordi-
nary sterilized gauze, or any other thoroughly clean material, dry if
possible.

Wounds of the skull if penetrating are usually accompanied by
injury to the brain which will be manifested by unconsciousness,
paralysis, unequal pupils, etc. No special first-aid treatment is re-
quired.

Woitmds of the chest if penetrating are usually attended by injury
to the lungs. The signs of penetration of the chest cavity are the
presence of air bubbles in the wound, difficult breathing, cough, and
spitting of blood. The treatment consists in laying the patient on
the injured side and firmly bandaging the chest.

Wounds of the abdomen may or may not be penetrating, and there
may or may not be injury to the viscera. The signs of injury of the
intestine are the escape of gas or feces through the wound and the
passage of blood in the stools.

Injury to the stomach may be attended with the escape of its con-
tents and by vomiting of blood. No special first-aid treatment is
required in these conditions, except that the patient should be placed
in such a position as may favor the escape externally of the contents
of the intestinal tract.

Injury of the bladder is shown by the escape of urine through the



94 FIRST AID

wound and the passage of blood in the urine; if these signs are
present the urine should be drawn frequently to prevent its escape
into the abdomen.

In all cases of injury to the abdominal viscera the signs of shock
are usually well marked.

Poisoned wounds may be divided into those in which the poison
is chemical, including the bites and stings of insects, scorpions, ta-
rantulas, centipedes, and snakes; and those in which it is bacterial,
including the bites of man and other animals, not rabid, the bites of
rabid animals, and wounds infected with tetanus or anthrax.

The bites and stings of insects cause considerable smarting and if
in loose tissues often much swelling; relief may be afforded by the
application of ammonia, soda, or even wood-ashes; the sting if left in
the wound should be extracted. The bites of the tarantula and centi-
pede and the sting of the scorpion may cause great pain, considerable
shock, and much local swelling and inflammation, but are seldom or
never fatal. The treatment is the same as for the bites of other in-
sects, but in very severe cases it may be necessary to incise the
wound and suck out the poison. Stimulants may be given if neces-
sary and morphine for the pain.

When a person is bitten by a poisonous snake, of which the rattle-
snake and copperhead are the principal varieties in this country,
prompt action is required.

If the wound is in the extremity tie a bandage or handkerchief
tightly about the limb above the wound ; incise the wound freely and
suck out as much of the poison as possible ; then with a hypodermic
syringe inject a two-per-cent solution of permanganate of potash into
and about the bite so as to destroy any poison which is left. If a hy-
podermic syringe and permanganate solution are not available, the
bite should be cauterized with a lighted match, a hot coal, or a lit-
tle gunpowder rubbed in and ignited. Meanwhile give stimulants
freely but not to the point of intoxication. The ligature should be
loosened about every half-hour so as to allow restoration of the cir-
culation, but should be immediately tightened up if symptoms of
general poisoning occur.

The bites of man and other animals not rabid are always more or
less poisonous from the presence of the bacteria constantly found in
the mouth and on the teeth ; sometimes they are fatal ; such wounds
should be thoroughly disinfected and wet antiseptic dressings applied.



EMERGENCIES, CONTUSIONS AND WOUNDS 95

Rabies or hydrophobia is a very fatal disease caused by the bite of
a rabid animal or " mad dog." The effect is not immediate like that
of snake bite, but may be delayed weeks or months.

The treatment of the bite when the animal is known to be rabid
is exactly like that of snake bite, but no ligature need be used.

Tetanus or lock-jaw is a disease the result of a wound infected by
the bacillus of tetanus. It is especially apt to occur after toy-pistol
wounds or any wound in which dirt has been carried deeply into the
tissues. It has been very common in wars where the fighting occurs
in trenches made in cultivated fields which have been enriched with
stable manure.

The tetanus germ grows best in the absence of air; hence it
thrives in deep, punctured wounds. The germs are found in the soil
especially about gardens, stables, and in the streets. Wounds of
such a character should be opened up freely, disinfected, and drained.
If available, tetanus antitoxin should be injected into and about
the wound.

Anthrax or malignant pustule is sometimes caused by the t>ite of
an infected fly. It starts as a very hard swelling like a carbuncle,
often on the lip. If its nature is recognized it should be at once ex-
cised.

In warfare with savage peoples the latter often used poisoned
weapons, especially arrows. Many different poisons are used, vege-
table, animal, and bacterial.

The local treatment is the same as that of snake bite; the general
treatment must be symptomatic, unless the nature of the poison is
known.



CHAPTER II

HEMORRHAGES

IN capillary hemorrhage there is a steady oozing of red blood from
all over the wounded surface; nature's method of arresting such a
hemorrhage is by the coagulation or clotting of the blood in the
mouths of the tiny vessels, and by the contraction of their cut ends.
In treatment we imitate nature. The part should be elevated and
very hot or very cold water applied to the wound ; the effect of either
one is the same as the other, the result being the contraction of the
vessels, coagulation of the blood, and arrest of hemorrhage.

After this, uniform pressure applied to the wound by means of a
gauze compress and bandage is all that is required.

EpistOrxis or nose-bleed is a form of capillary hemorrhage which
is sometimes difficult to control; the arms should be held by an
assistant vertically above the head, and a sponge dipped in cold water
applied to the back of the neck between the shoulders, and another
over the root of the nose; very cold or very hot water should be
snuffed up the nose; if this fails an astringent should be added to
the water alum or tannic acid. Should the bleeding still continue,
plug the nostrils with absorbent cotten; but if the blood then runs
into the throat from the back of the nose, the assistance of a surgeon
will be required.

Capillary bleeding from a tooth socket is sometimes excessive;
plug the cavity with a narrow strip of gauze, place a compress over
the gauze, and bandage the lower jaw firmly against the upper.

In venous hemorrhage there is a rapid flow of dark blood, a welling
up as it were, without any spurting. In the treatment the first step
is to elevate the part ; so little velocity is there in the venous current
that elevation alone will often stop the bleeding; if it does not,
pressure must be made directly over the wound, and hot or cold
water may be applied if necessary ; if in an extremity, the limb should
be bandaged from the toes or fingers up to the bleeding point, in
addition to the pressure over the point.

(96)



HEMORRHAGES



97



In arterial hemorrhage the blood is bright red in color and escapes
in jets. Nature's method of arresting such a hemorrhage is by the
formation of a clot, the contraction of the muscular coat of the artery
lessening the caliber, and the retraction of the middle and inner coats
affording an obstacle to the escape of the blood and favoring clot for-
mation, and the diminished force of the blood flow caused by the
weakening of the heart's action, the result of the hemorrhage.

When fainting follows the loss of blood the hemorrhage often
ceases at once because the heart's action is so weak that it cannot
force out the clot which
forms in the mouth of
the vessel; in such a
case, however, the bleed-
ing is apt to start again
when reaction takes
place, or when some
sudden movement dis-
places the clot. The
recurrence of bleeding
with reaction is known
as intermediate hemor-
rhage to distinguish it
from primary hemor-
rhage, that which occurs
immediately on receipt
of the wound, and
secondary, that which
occurs at a still later period from the reopening of the artery by the
slipping of a ligature, or from an extension of sloughing or ulcera-
tion to the vessel.

In the treatment of arterial hemorrhage prompt action is required ;
bleeding from a large artery like the femoral may cause death in a
minute or two ; as a matter of fact a large proportion of the deaths
on the battlefield are due to hemorrhage.

The thing to be done is to compress the artery between the wound
and the heart, or if that cannot be done then in the wound itself; the
point selected for pressure should be where the artery crosses a bone
because there it can be made most effective. If a hose connected
with a hydrant breaks we stop the flow of water by putting a foot
7




FIG. 43. Compression of the Femoral Artery.



FIRST AID




upon the hose between the broken part and the hydrant ; we apply
the same principle in arterial hemorrhage. The pressure should be
made with the fingers, preferably the thumbs, and should be firm
enough to arrest the bleeding (Fig. 43) ; it should be made over the
clothes, as too much time may be lost in removing them. You will

know that you are pressing on the
right place by feeling the artery beat-
ing beneath the fingers and by the
arrest of the bleeding; if you cannot
find the artery make pressure directly
over the bleeding point. As pressure
with the fingers soon becomes tire-
some, get an assistant to slip his
thumb over yours, and take your
place while you prepare a tourniquet.
The principle of all tourniquets is a
pad over the artery to bring the pres-
sure on the artery and take it off the
veins, a band around the limb and
over the pad, and some means of
tightening the band. There are a
number of special tourniquets, but as
they are not usually at hand a suitable one must be improvised ; an
excellent tourniquet may be improvised with a rubber bandage; a
number of turns are made about the limb and the rolled portion of
the bandage then placed under the last turn in such a position as to
press directly upon the artery (Fig.
44). The most common improvised
tourniquet is the Spanish windlass;
in this arrangement any rounded,
smooth, hard object, such as a stone,
a cork, or a roller bandage, is used as
a compress ; for the band a handker-
chief, a suspender, a waistbelt, a
bandage, or anything of the sort may
be used; to tighten up the band a
stick or bayonet, scabbard or some-
thing of the kind is passed under
the band and twisted until the FlG _ , _ Spanish Windlass .



FIG. 44.



ompression of the Femorral
Artery by a Rubber Bandage.




HEMORRHAGES



99



bleeding ceases, when the ends of the stick are tied to the limb to
prevent the band from becoming untwisted (Fig. 45). A tourniquet
applied tight enough to stop arterial hemorrhage causes pain and
swelling of the limb, and if left long enough may cause gangrene of
the part ; it should therefore be watched and loosened up from time
to time, say every half-hour or so. If on loosening the tourniquet

the bleeding starts again tighten
it up; if there is no appearance
of bleeding leave the loose tourni-
quet in place with an attendant
watching to tighten it up should
the hemorrhage recur.

The surgeon arrests the hem-
orrhage permanently by tying or
twisting the divided ends of the
artery.

Fig. 46 shows on the skeleton
the points at which the various
arteries may be compressed to
the best advantage.

For bleeding anywhere in the
upper extremity below the mid-




Fic. 46. Skeleton with Black and Dotted
Lines Showing the Course of the Arteries
and a x Indicating the Pressure Points.




FIG. 47. Compression of the Brachial
Artery.



die of the arm compress the brachial in the manner shown in Fig. 47
and then apply a tourniquet a little higher up. If the wound is



100



FIRST AID



low down in the palm of the hand, it may not be desirable to
arrest the circulation in the entire limb, in which case the pressure
may be made in the palm by a roller bandage over which the fingers
are doubled and tied in place with a bandage (Fig. 48) ; or we




FIG. 48. Arrest of Bleeding from the Palm.



may put a pad in the elbow and bend the forearm on the arm and
tie the two together (Fig. 49).

If the wound is in the axilla, pressure must be made on the sub-
clavian against the first rib arid in the hollow behind the clavicle





FIG. 49. Flexion of the Elbow to
Arrest Bleeding Below.



FIG. 50. Compression of the Sub-
clavian Artery.



(Fig. 50) ; as a tourniquet cannot be applied here the fingers may be
relieved by making the pressure with the handle of a large key, or
the end of a pocket knife well wrapped.

In bleeding from any part of the lower extremity compress the



HEMORRHAGES



101



femoral against the head of the femur just below the middle of the
groin, with both thumbs, as shown in Fig. 43, then apply a tourni-
quet to replace the thumbs.

If the bleeding is from the foot another method is to put a pad be-
hind the knee and flexing the leg forcibly, tie the leg to the thigh as




FIG. 51. Arrest of Bleeding by Flexion of the Knee.

shown in Fig. 51 ; if from the top of the foot a tourniquet may be
placed over the anterior tibial in front of the ankle, or if from the
sole of the foot over the posterior tibial behind the inner ankle.




FIG. 52. Compression of the Carotid.




Fl3. 53. Compression of
the Temporal Artery by
Knotted Bandage.



Hemorrhage of the neck from the branches of the carotid is con-
trolled by compression of the carotid with the thumb against the ver-
tebrae (Fig. 52) ; a tourniquet cannot be applied here.



102 FIRST AID

Bleeding from the tongue may be controlled in the same way, or
by rinsing the mouth out with ice water, or holding pieces of ice in
the mouth.

Bleeding from the lips may be very severe; it is controlled by
grasping the lip between the thumb and fingers; as the arteries of
the lip come from both sides, pressure must be made on both sides of
the wound.

Bleeding from the face may be arrested by pressure on the facial
artery in front of the angle of the jaw.

Bleeding from the scalp is easily arrested by pressure with a com-
press on the bleeding point, the pressure being made by a knotted
bandage as shown in Fig. 53.

In bleeding from the lungs the blood is bright red, frothy, perhaps



Online LibraryCharles Field MasonA complete handbook for the sanitary troops of the U. S. army and navy and national guard and naval militia → online text (page 8 of 38)