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 9 of 38)
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mixed with mucus, and is coughed up. Listen over the chest and
where rattling is heard apply an ice bag; give the patient pieces of
ice to swallow, and keep him perfectly quiet in the recumbent posi-
tion ; he should neither talk nor move.

In bleeding from the stomach the blood is vomited, is usually dark
in color, and may be mixed with food. It is always well to remember
that vomited blood does not necessarily indicate hemorrhage from
the stomach ; the blood may have been swallowed, coming from the
back of the nose or throat ; inquire whether there has been any nose-
bleed. The treatment is the same as for hemorrhage from the
lungs, except that the ice bag is applied over the stomach.

In bleeding from the bozi'els the blood is bright red if fresh ; black
and tarry if old. All that can be done is to apply cold applications to
the abdomen and keep the patient quiet.



A dislocation is a permanent slipping away from each other of the
bones which form a joint, with locking of the bones in the new posi-
tion ; the joint is out of place. Necessarily the dislocation is attended
with tearing of the ligaments and often with rupture of the muscular
attachments as well.

The cause is usually indirect violence especially falls and twists.
In attempting to save one's self from falling the hand is thrown out
and the weight of the body coming on it causes a dislocation of the
shoulder ; or the thigh in falling is bent backward, resulting in dislo-
cation of the hip.

The symptoms of dislocation are as follows : The patient has fallen
and cannot move the affected joint ; there is pain of a sickening char-
acter, often with numbness or tingling in the limb below from pres-
sure on the nerves and blood-vessels ; on attempting to move the joint
we find that it is locked and cannot be moved ; on uncovering and
examining it, it will be noticed that there is marked deformity in the
joint, and that the limb is fixed in an unnatural position, and appears
longer than the corresponding limb on the other side.

A dislocation must always be carefully distinguished from a frac-
ture or a sprain. In fracture there is unnatural movement between
the joints instead of immobility at the joint, and the movement is
attended with a grating sensation and sound; the deformity is be-
tween the joints and there is usually shortening of the limb.

In sprains there is absence of any of the signs of dislocation except
swelling and pain ; the joint can be moved, though the patient will
resist on account of the pain. Always uncover the limbs and com-
pare the corresponding joints on the two sides.

If the services of a surgeon can soon be obtained nothing should
be done for dislocations except to loosen the clothing about the in-
jured part and support it as comfortably as possible in the new po-
sition. If the patient must be moved the limb should be supported
in a sling, or by splints and bandages.




When, however, a physician can not be reached for some time,
there are certain dislocations which a hospital-corps man may
attempt to reduce. He must always remember that no force is to
be employed, as it may do serious damage to the important vessels
and nerves near the joint ; the secret of success
lies in the skillful manipulation with a clear
understanding of the anatomy of the joint.

Dislocation of the shoulder occurs more fre-
quently than dislocation of all the other joints
in the body taken together; the reason of this
has been explained on page 43 ; the most common
dislocation of the shoulder is downward (Fig.
54). The symptoms are those described for dis-
locations in general ; there will be a hollow under
the point of the shoulder which will be very con-
spicuous when compared with the convexity on the other side and
the head of the bone can be felt in the arm pit where it should not

FIG. 54. Subgle-
noid Dislocation of
the Shoulder.

Fie. 55. Reduction of Dislocation of the Shoulder by the Foot in the Axilla.

be. To reduce this dislocation place the patient on his back on the
ground ; sit beside him ; remove one shoe from your foot and place
that foot in the patient's axilla ; -then using the foot as a fulcrum,
draw the arm downward in the direction of its axis, then outward,
and finally carry it across the chest (Fig. 55) ; or Kocher's method


may be tried as follows : Flex the forearm to a right angle, bring
the elbow to, the side; carry the hand and forearm outward; then lift
up the elbow and sweep the forearm across the front of the chest.
If successful the numerous will suddenly slip into place with a click;
the arm should then be bandaged to the side for a week or two to
give the torn ligaments a chance to heal If unsuccessful after a
few minutes' trial further attempt should be postponed. A shoulder
once dislocated is usually permanently weak, and the dislocation is
apt to recur from slighter violence than at first.

In dislocation of the lower jaiv (Fig. 56) the patient can not speak
or close the jaws, and is in great distress.

This dislocation is usually re-
duced without much difficulty,
but there is great danger of the
thumbs of the operator being
bitten. Wrap the thumbs well
with a handkerchief or band-
age; stand in front of the pa-
tient, and while pressing with
the thumbs in the mouth just
back of the last lower molars at FlG - s6 -~ Dislocation of the Lower J w -
the same time with the fingers

lift up the chin ; the jaw will usually at once snap into place, and the
thumbs must be quickly withdrawn to prevent them being bitten.
After reduction bind the lower jaw to the upper with a four-tail

In dislocation of the finger joints pull on the dislocated end, at the
same time bending it backward if the dislocation is forward, or for-
ward if the dislocation is backward, and pushing the joint into place.
After reduction strap or splint the finger.

The patella or knee-cap may be dislocated outward or inward;
there is sickening pain, the knee cannot be moved, and on examina-
tion there is a hollow in front of the knee where there should be full-
ness, and the patella can be seen and felt in its new position.

Extend the knee as much as possible and ^ex the thigh so as to
relax the muscles, when the patella can usually be pushed into place.

In sprains the joint surfaces slip apart, tearing the ligaments, but
slip back into place again ; a sprain is really a momentary dislocation.
The tearing of the ligametns causes hemorrhage into and around the




joint, and as the blood can not escape externally the joint is immedi-
ately swollen; that the swelling is due to the bleeding is shown by
the black and blue discoloration of the skin over the joint which
begins to appear after a day or two as the blood comes to the

The treatment consists in stopping the hemorrhage, causing the
absorption of the blood already poured out, and supporting the joint
until the ligaments heal.

A sprained ankle, the most common of all sprains, may be taken
as a type. The patient twists his foot stepping on a stone, there

is sharp pain in the ankle,
lameness, and prompt swell-
ing of the joint, but the joint
is movable, thus excluding
dislocation, and there is an
absence of the signs of

To contral the bleeding put
the foot at once into a pail of
hot water, as hot as can be
borne, and keep it there ten
minutes ; or if there is no
water hot enough use ice
water. Next shave, dry and
powder the foot and then
strap the joint firmly with
rubber adhesive plaster, using
strips about an inch wide and
fifteen to eighteen inches
long (Fig. 57). The first strap should form a stirrup of the heel,
closely following the tendo Achillis on each side ; the second should
cross the first at a right angle, extending along the border of the
foot from the root of the little toe to the root of the great toe or
vice versa; the third strap covers one-third of the first and the fourth
one-third of the second and so on until the entire ankle is covered
except a narrow strip in front which is left open to allow of free cir-
culation. Each strap is drawn tight and the crossings are made
strongest over the swelling. When the strapping is completed a
bandage is applied over all until the plaster is firmly adherent, when

FIG. 57. Strapping the Ankle.


the bandage is removed, the sock and shoe put on and the latter
firmly laced, after which the patient should begin to walk, commenc-
ing with a crutch or cane.

The walking is at first very painful, but must be persisted in, as
the plaster takes the place of the torn ligaments and the movement of
the joint in walking causes rapid absorption of the blood. As the
strapping becomes loose it must be reapplied after thorough massage
of the joint.


FIG. 58. Green-stick Fracture.


A fracture is a broken bone. There are two great classes of frac-
tures, simple or closed and compound or open.

A compound or open fracture is one in which there is a wound

communicating with the broken ends of the bone ; the broken bones

are open to infection, A
simple or closed fracture is
one in which the broken bones
are closed to the air and to
infection in that there is no
wound communicating with
the fracture.
A fracture is comminuted when the bone is broken into more than

two pieces; complicated when there are also injuries to the adjoining

vessels, nerves, or muscles; impacted when the broken ends are

driven into each other so that they can not move ; green stick when

the bone is bent and only partially broken as a green stick is broken

(Fig. 58).
Fractures are caused by direct violence, as when a wagon wheel

passes over a limb and breaks it ; indirect violence, as when a man

falls on his hand and breaks his collar bone; muscular action, as

when one breaks his arm throwing a ball.
How will you know that a fracture

has occurred? First there is a loss of

power in the part; if the leg is broken

the man has fallen and can not get up ;

if it is the arm he can not use it. Then

the limb is in an unnatural position ; if

you compare it with the uninjured limb

you will see that there is a deformity

between the joints, and that the injured limb is probably shorter.

If you attempt to move the limb you find there is movement


FIG. 59. Union of a Fracture.



between the joints where there should be none, and you can both feel
and hear the broken ends of the bone grating together crepitus.

The patient complains of great pain and tenderness at the seat of
fracture and there is swelling there due to bleeding from the broken
ends. There is a history of violence and often the patient will say
that he heard the bone crack and give way.

In the treatment of fractures the great point is to keep them from
becoming open ; a closed fracture is a very simple matter, not danger-
ous to life, and usually healing promptly if kept quiet in proper po-

FIG. 60. Use of Wire Gauze as a Splint.

sition ; an open fracture is quite another matter, always taking a long
time to heal and often threatening loss of limb and even life from

Therefore never attempt to move a man with a fracture until the
fracture has been fixed so that the broken ends of the bone can not
move. If a physician can be obtained at once merely make the
patient comfortable with pillows and supports where he lies; if he
must be moved apply splints, handling the broken bones very care-
fully so that sharp ends may not come through the skin and make the
fracture compound. If a physician can not be reached for a day or
two set the fi^cture and then splint it.



The cause of deformity in fractures is muscular contraction, and
this contraction must be overcome in setting the fracture, which is
merely getting the broken ends into proper position ; this is done by
extension and counter-extension; extension is pulling the far end
of the limb, and counter-extension is merely holding the end next
the trunk ; pull until the deformity and shortening disappear and the

FIG. 61. Splints of Telegraph Wire.

two limbs look alike, then hold them so while the splints are

When a fracture is properly set the blood which escaped into the
tissues about the break is gradually absorbed and at the end of a
week or ten days callus is thrown out or the limb begins to knit;
calus is a soft, cement-like substance which is poured out between
the broken ends around them, and in the medullary cavity; the callus
gradually hardens into bone. That which is around the break form-
ing a sort of ferrule or splice, and that in the medulla forming a pin,
are absorbed after many months ; but that between the bones remains



permanently, knitting the bone together (Fig. 59). Sometimes the
callus is not sufficient in quantity or quality and union fails to take

When a fracture is already open or compound the object of treat-
ment is to convert it into a simple fracture, or at least to prevent in-
fection. The wound is first dressed and then the fracture is treated.

A splint is merely a splice to hold the bones in proper position
until nature unites them. Splints must be light but sufficiently rigid
to prevent bending; long enough to fix the joints above and below
the fracture; broad enough to prevent pinching of the limb in band-
aging; sufficiently padded to protect the part from undue pressure.

FIG. 62.

FIG. 63.

There are many splint materials supplied, among the more com-
mon being thin boards, cardboard, felt, leather, wire gauze (Fig. 60),
etc. Often in the military service splints must be extemporized ; one
of the most useful and most accessible materials for preparing them
is telegraph wire ; the method of using it is illustrated in the figures
(Fig. 6 1 ) . On the battlefield the various weapons may be employed :
rifles, bayonets, swords, scabbards (Fig. 62), and tent pins; splints
may also be prepared from blankets and straw, from hay, small



Sticks, the bark of trees, barrel staves, broom handles, canes and

Padding may be made of clothing, hay, straw, grass, leaves, excel-
sior, cotton, crumpled paper, etc.

The best things to hold splints in place are straps which can be
readily buckled and unbuckled; the next best is the loop bandage
applied as shown in Fig. 64; roller bandages, triangular bandages,
tape, and many other things may be used. Before the splints are
applied permanently the limb is usually bandaged from the extremity
up to the fracture in order to prevent swelling below ; after the ap-

plication of the splints another bandage is applied over all. Be
careful not to make the dressing too tight, and always leave the tips
of the fingers exposed so that the circulation may be watched. If the
tips of the fingers are blue and cold, or if upon pressing the blood out
from under the nails it does not quickly return the dressing is too

After splinting the upper limb it must be placed in a sling; if
there are no materials available to form one, the coat sleeve may be



simply pinned to the coat, or the flap of the blouse may be turned up
and pinned, ripping the seam if necessary (Figs. 65 and 66).

Fractures of the skull and spinal column are chiefly of importance
on account of the coincident injury to the important parts of the ner-
vous system which lie immediately beneath the bone. In fractures of
the skull, unless compound or depressed, all the usual symptoms of
fracture are- absent, or entirely overshadowed by the injury to the

FIG. 65.

FIG. 66.

brain. The most prominent brain symptoms are loss of conscious-
ness and paralysis; if the loss of consciousness is sudden i
probably due to the pressure of a piece of bone ; if it comes on slowly
it is apt to be the result of hemorrhage from a torn vessel. In frac-
tures of the base of the skull there may be bleeding from the nose
or ears, or into the orbits and under the. conjunctiva ; the escape



cerebro-spinal fluid a clear, watery serum from the ears is con-
sidered a sure sign of fracture of the base.

Treatment : Keep the patient quiet in a recumbent position and

apply an ice bag to the head ; if the fracture is compound a dressing

will be required.

In fractures of the spinal column the spinal cord is generally in-
jured or cut across, with resulting paralysis
of all parts below the fracture. On ex-
amination, irregularity of the spinous pro-
cesses will be noted, usually with angular
deformity. Handle the patient with great
care so as not to produce or increase injury
to the spinal cord. Before moving him
apply splints on both sides, from his arm-
pits to his feet, so as to make the body as
rigid as possible, then work a blanket under
him, and, drawing it as tight as possible,
lift him on a litter.

FIG. 6 7 ._ Four-taii Bandage Fractures of the ribs and pelvis are also
for Fracture of jaw. chiefly important on account of the injury

to the contained viscera.

In fracture of the ribs the sharp end of the bone is apt to stick into

the lung every time the patient breathes; hence in these cases the

patient will often complain of a sharp pain when he breathes,

and there may be cough, with spitting of

frothy blood. When the fingers are passed

firmly along the ribs they may be felt to give

at the broken point, which is also very tender.
The treatment consists in confining the

movements of that side of the chest as much

as possible, in order to give the broken bone an

opportunity to rest and knit. This is done by

circular bandaging of the whole chest or by

strapping one side.

The pelvis is so strong that the bones are

broken only by the most severe direct violence,

as when a heavy wagon passes over it. The

symptoms are inability to stand or sit up, and crepitus felt

when firm pressure is made. If there is an injury to the bladder the

FIG. 68.



urine contains blood. The treatment consists in the application of
splints on both sides from the axillse to the feet ; if the bladder is
injured a catheter must be introduced and left in, so that the urine
will not accumulate and escape into the peritoneal cavity.

In fracture of the nasal bones there is usually considerable deform-
ity, the bridge of the nose being caved in and pushed to one side ;
crepitus is generally to be felt, and there is considerable nose-bleed!

Check the bleeding by syringing
with hot or cold water; push the
bones into place by means of a probe
or slender, smooth stick in the nostril,
aided 'by the fingers outside. Apply
cold dressings over the bridge of the
nose and warn the patient not to
attempt to blow the nose.

In fracture of the lower jaw the
line of teeth is irregular and there
may be bleeding from the mouth ; the
patient can not open his mouth, and
the fracture can usually be readily
felt. FlG - 6g -

Push the bones into place and apply a four-tailed bandage (Fig.
67) or two narrow cravats. The patient can not chew and will have
to live for a time on liquid foods taken through a tube.

In fracture of the clavicle the attitude of the patient is often char-
acteristic; the shoulder drops downward, inward and forward, and
he attempts to support it by holding the elbow of the injured side in
the hand of the sound side. The collar bone lying immediately under
the skin, the fracture is easily made out.

As a first-aid dressing, put the arm in a large sling, place a pad
in the axilla, and bind the arm to the side. The fracture is put up
permanently in a Sayre's dressing or a Velpeau bandage.

Fracture of the humerus or arm bone
has all the common signs of fracture and
may ordinarily be recognized without diffi-
culty. Two splints are required; they
should be placed on the inner and outer
sides, except in fracture near the lower end of the bone, when the
splints should be front and rear (Fig. 68).

FlG. 70. Colics' Fracture.



If the fracture is near the shoulder joint a shoulder cap must also
be used, and if near the elbow joint the inner splint should be rectan-
gular and include the forearm. The wrist should be supported in a
sling, leaving the elbow hanging down so as to produce extension.
If no splints are available the arm should be at least bandaged to the
side or placed in a sling.

When both bones of the forearm are broken all the usual signs of
fracture are present. Place a splint on each side, from the elbow to
the root of the fingers, and put the arm in a sling (Fig. 69).

As a general rule, in all fractures of the upper extremity flex the
elbow to a right angle, and place the forearm in such a position that
the thumb will point up.

The reason of this is, that should the elbow become stiff, the arm
is more useful in that position than any other; the thumb should
point up, that is, the forearm be midway between pronation and
supination, for in that position there is the widest possible space
between .the radius and ulna, and therefore they are less apt to
become fused together by the callus which is thrown out in the
process of union.

Fracture of the radius alone, just above the wrist, is very common
and is known as Colics' -fracture. It is attended by a peculiar silver-

FIG. 71.

fork deformity (Fig. 70), and as the bones are usually impacted,
crepitus is absent. The setting of this fracture can only be properly
done by a surgeon ; meantime the arm should be placed in a sling.

Fracture of the metacarpals a broken hand usually occurs in
a fight. The most prominent signs are deformity and pain. Splints
should be applied on the back and front of the hand, reaching from
the finger tips half-way up the forearm.

Fractures of the fingers are treated by the application of narrow
finger splints, usually on the palmar surface only.

In fractures of the femur all the common symptoms of fractures



are usually present ; the foot may be everted, lying on its outer side,
and the leg is shorter than the other. Two splints must be applied ;
the one on the outside reaches from the armpit to beyond the foot ;
the one on the inside from the crotch to the foot (Fig. 71). The
splints should be tied on in five places : around the ankles, over the
knees, just below the hips, around the pelvis, and just below the
axilla. It is well also to tie the two limbs together.

FIG. 72. Dressing for Broken Knee-Cap.

So powerful are the muscles of the thigh, constantly tending to
make the bones overlap, that in the permanent treatment in hospitals
it is customary to provide special arrangements for overcoming the
muscular action.

These arrangements comprise what is called extension. A weight
is attached to the foot by adhesive-plaster straps, and a cord run-
ning over a pulley, and counter-extension is provided by raising the
foot of the bed, thus utilizing the weight of the body.

Fractures of the lower extremity are always put up with the entire

FIG. 73.

limb straight, so that if the joints get stiff the limb can be at least
utilized for standing and walking.

In fractures of the patella or knee-cap the patient can not stand or
walk; the upper fragment is drawn up the thigh by the powerful
muscles attached to it, and the gap can be readily felt. The joint
swells up at once. A splint should be applied to the back of the knee


so as to keep the limb extended, and the upper fragment should be
brought down by figure-of-eight bandaging (Fig. 72).

If both bones of the leg are broken the fracture is very apt to be
compound because fracture of the tibia is usually oblique with a
sharp point that may come through the skin ; such a fracture should
be handled with the greatest care. Apply splints from the knee to
beyond the foot on the inside, outside, and behind (Fig. 73). Tie
the feet together.

Fracture of the fibula alone just above the ankle is called Pott's
fracture, the signs are usually indistinct, but if the lower end of the
tibia is fractured as well there is apt to be marked eversion of the

Treat in the same manner as a fracture of both bones, except that
the posterior splint is not necessary.

Fractures of the bones of the foot are best treated by a plaster-of-
Paris dressing.



In the eye: Foreign bodies, such as particles of dust, cinders, etc.,
may lodge under the lids, upon the conjunctiva, or upon the cornea.

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 9 of 38)