PART I.
THE SURGICAL DRAWER.
fair critic asked us the other day why all our articles were written for Londoners—why we had never addressed our remarks to girls living in out-of-the-way districts at home or in the colonies?
Truly we do not know what difference it makes if these papers are written in London or for Londoners. Health and sickness are much the same all over the world, and the chief difference between England and the Gold Coast as regards disease is the prevalence in the latter of maladies which are peculiar to the land. And the discussion of these would not afford interest to any save such as are living there.
But we will address this article chiefly to persons living in remote parts where medical aid is not always easy to obtain.
We were buying some drugs yesterday, and when we had finished our purchases, the chemist showed us a wonderful “new toy” which had just been sent to him. It was called “The Patients’ Vade Mecum.”
Vade Mecum—go with me—evidently something to be carried about with one—a pocket-case, in fact. Oh, but this was not a pocket-case! It was a great chest—like a family deed-box. It was bound and studded with brass nails, and was a very tolerable load for a strong man to carry. Not at all what we should call a Vade Mecum.
Let us describe this chest. Follow it carefully, for we are describing the exact reverse to what any sensible person would have in her house!
There was a grand brass lock and two keys. Unfortunately, neither of the keys fitted the lock, so that it was at least half a minute before we could open the thing. When at length the lock yielded, the interior of the box presented a sight which we shall never forget. There was quite a forest of clean little corks. There were in the upper compartment one hundred and forty-four clean, sweet, little one-ounce bottles, all neatly labelled and fitted with the pretty little corks which were the first things that attracted our attention. These bottles were arranged in rows of twelve abreast, and there was not a stain on any one of them.
We took hold of one and tried to pull it out from amongst its fellows, but it wouldn’t come. However, a good hard tug displaced it, and with it two or three others which rolled to the ground, and we held in our hand a one-ounce bottle of—of—well, the name of the stuff slips us altogether—anyhow, it was quite new to us. Underneath the name of the preparation was written “Cure for Gout.”
This looked interesting, so we examined the other bottles and discovered that the hundred and forty-four bottles contained a hundred and forty-four preparations—all guaranteed different—which “cured” a hundred and forty-four diseases!
But the odd thing about it was, we had never before heard of any of the drugs, nor did we know half the diseases which these wonderful drugs cured. There was one bottle to cure “humours” of the face. What on earth are they?
We cannot rise to this. But there is a drawer underneath. Let us open it and see what it contains. More bottles! Bigger ones this time. One, we see, contains tincture of arnica—guaranteed to remove all effects of “injuries, bruises, and inflammations.” This is coming it too strong! We know tincture of arnica, and we know that some people have an idea that it does something or other to relieve bruises—an idea which we do not share. But to say it removes all effects of injuries, bruises (we should have thought that these might have been included under the former term), and inflammations—well, we live and learn.
There were five other bottles in this drawer. And then there was a pair of scissors. What can they be for? But then we found a roll of sticking plaster, and the mystery was cleared up at once. This is intended for the surgical part of the box. Fancy a surgery containing six bottles, a pair of scissors, and a roll of plaster!
And quite enough too, if one of the bottles contains a balm which will remove all effects of injuries and inflammations. But then what is the good of the other five bottles, the pair of scissors and the plaster?
“What do you think of my box?” asked the chemist when we had finished our exploration. “How much do you think that cost?”
“Dear me, man, you don’t mean to say you bought that?”
“No,” he replied, “I didn’t. It was sent to me as an advertisement. They are selling them at £5 5s. a-piece, and they asked me to take a dozen and try to dispose of them. What would you do if you were in my place?”
“Well,” we replied, “we would empty the bottles, clean them, and use them for better purposes, as they may be required, and the box you might give to your daughter as a workbox.”
But another person standing near was not disposed to think so lightly of the matter, and told the chemist that he ought to telegraph at once to the people who had had the impertinence to send a respectable chemist such a concern, saying, “If you do not remove your rubbish within twenty-four hours, I’ll sue you for warehouse room.”
These homœopathic cases are very popular, and many persons buy them thinking that they can do what they pretend to do. We cannot warn you too strongly against purchasing these things. Avoid them as you would poison. No, we do not mean to be taken literally. There are no poisons in these chests. We have a law which prevents the indiscriminate sale of poison.
Now let us describe our medicine chest. Oh, let us see what we want it for before we fit it up.
You do not want a medicine chest to contain everything you may require. You want it to contain everything that is absolutely necessary for emergencies. There are practically three classes of emergencies—injuries, acute poisoning, and acute disease.
The surgical part of the box is far more important than the medical part. Let us talk about injuries first. Bleeding requires instantaneous treatment. If a person wounds a big vessel, she may bleed to death in half a minute or less. So you must act at once if you wish to be of any value.
You can stop bleeding of any kind instantly by pressure. Never forget this. Never go running about to look for a tourniquet or what not when a great vessel has been cut. Press on the bleeding place. Press at once. You do not want very much force to compress an artery; but the force must be continuous. When you have stopped the flow of blood, then think of sending for assistance. When a person is bleeding from a deep wound, press the lips of the wound together. Not the edges only—this is no good. Press the complete thickness of the lips of the wound together. If you cannot do this, stuff your handkerchief into the wound and press on that.
A not uncommon cause of bleeding to death is rupture of a varicose vein. Hundreds of thousands of women have varicose veins, but in very few do the veins rupture. Still, if a vein does get torn and the patient does not know what to do, her life will be lost while seeking assistance.
If you have a varicose vein, it will almost for certain be in the leg, and if it bursts, you will feel the hot stream of blood and rapidly become faint. When this occurs, lie down on the floor and elevate the leg as high as you can. This alone may stop the bleeding. If it does not, press your finger on the spot, and then send or call out for assistance. The slightest pressure will stop bleeding from a vein.
In these cases of serious bleeding, send for a surgeon as soon as you have applied pressure. In all probability the vessel will have to be tied. But if the nearest surgeon is two or three hundred miles away, keep up the pressure and get someone else to put on a bandage pressing very tightly upon a pad, which in its turn presses upon the bleeding vessel.
In the case of a varicose vein or a small artery, this treatment will probably prove successful.
Whenever you cut yourself, the raw surface bleeds more or less. You can stop this kind of bleeding either by pressure, or by hot water. There is never anything to be alarmed at when blood oozes out from a wound, even though a considerable quantity of blood be lost. As long as there are not jets of blood, there is little danger in bleeding. Pressure will soon stop this form of bleeding.
That will do for the first and most important of all emergencies. What have we to put in our box for this purpose? Nothing at all. All we require is a hand and presence of mind.
Now about the treatment of wounds. First stop the bleeding, if this is severe. Then wash your own hands. Wash them well. Plenty of soap and hot water. Good hard work with the nail brush. Your hands should be absolutely clean before you meddle with a wound.
Now you will want some antiseptic. The best of all is carbolic acid. Mind you, this is poison. But if you are careful, and label the bottle and lock it up in your box, there is little danger in your possessing it. Your bottle of carbolic acid should be a good big one holding ten ounces at least. It should contain a solution of carbolic acid in distilled water of the strength of one part of pure crystallised phenol to twenty parts of water. It must be kept in a glass-stoppered bottle, which must be labelled—
“Carbolic Acid.
1 in 20.
POISON.”
When used for washing wounds dilute this fluid with four times its volume of warm boiled water. Having washed your own hands, thoroughly wash first with soap and warm water, and then with the carbolic solution, the skin round the wound of your patient. Do not be content with washing merely the immediate neighbourhood of the wound, but wash well round it in every direction.
Now to treat the wound itself. Take a perfectly clean basin and rinse it out with boiling water. Into this put your carbolic solution diluted with warm water to the strength of 1 in 80. Have plenty of the solution ready. Now wash the wound in the antiseptic. For this purpose you will require a small glass syringe and some pellets of perfectly clean absorbent cotton wool.
The wound must be absolutely clean—not a minute speck of dirt may be left in it. When you have washed the wound absolutely clean, take a small square of clean lint, wring it out in the solution of carbolic acid, and cover the wound with it while you take out the materials with which you are going to dress the wound.
You must not touch the table or the chair, and you must not touch your handkerchief or anything else, while you are dressing a wound. Microbes lurk everywhere except in the carbolic acid, and in the dressings, if they are clean. And if you are careful, you can prevent any germs from getting into the wound; and this is the most important thing in surgery. Do not let the dressings touch the table. Deposit them carefully on a clean towel, which you have previously wrung out with the carbolic solution, and laid upon the table.
Of course the dressing you use must vary a little with the nature of the wound you are treating. If the wound is sharp cut or is perfectly clean and not ragged, dust it over thickly with powdered boracic acid. Then cover it with a small piece of absorbent gauze—the blue “sal alembroth” gauze is the best. Swathe thickly in cotton wool and put on a clean bandage.
There is no need to again dress the wound, unless it becomes hot and painful. If you have got the wound absolutely clean, when the dressings have been on for a few days, it will have completely healed without discharging more than a few drops of fluid. If, however, the wound smarts, it must be dressed again, and possibly every other day. It should be dressed in the same way as it was in the first instance.
When the wound is very jagged, or impossible to get thoroughly clean, it is best to put on fomentations for the first day or two.
Fomentations have taken the place of poultices in modern surgery. Never put a poultice of any kind near an open wound. All your care and cleanliness will go for nothing if you do.
To make fomentations take a square of lint and fold it twice. Then wring it out in boiling carbolic solution (1 in 80) and apply it as hot as it can be borne. Cover it with a square of oiled silk, put on a thick layer of wool, and bandage. Fomentations should be renewed three or four times a day.
When treating a wound, never use sticking-plaster except to keep on a dressing. Sticking-plaster must never be placed on a wound, and above all it must not cover the wound. If it does so, it will keep the discharge locked up under it. The discharge will decompose, and a very serious state of affairs may intervene. Free drainage is essential in all wounds, and if this is interfered with, the wounds will go wrong.
What have we to put in our box for the treatment of wounds? The following—
Carbolic acid solution, powdered boracic acid, sal alembroth gauze, surgeon’s lint, absorbent cotton wool, oiled silk, bandages, pair of scissors, syringe (glass).
Burns are common accidents, and though they do not call for such rapid treatment as do wounds, nevertheless, it is always advisable to see to them at once.
The pain of burns and scalds is often very severe, especially when the flesh is not deeply burnt. You can relieve the pain by the application of sweet oil, or by an emulsion of sweet oil and lime water, sometimes called carron oil. The latter is better, but the former can be obtained in any household, so it is not worth while filling up your box with the emulsion.
After a burn, if the skin has not been destroyed, a blister will form. This blister can be left alone, pricked, or removed entirely. If you are not certain of cleanliness or you do not possess antiseptics, never open a blister. If you leave it, the liquid will become absorbed and the cuticle will flake away.
You are usually told to prick blisters as soon as they are fully formed. This treatment we cannot countenance. If you are sure of cleanliness, and the needle you use is absolutely sterile (i.e., free from germs), and if, moreover, your after-treatment is properly carried out, then there is no danger in pricking a blister. But no amateur ever is certain of perfect cleanliness. And we fail to see the advantage of pricking the blister after all.
Suppose the needle you use is dirty, just see what a state of things may occur. Your needle is dirty—it is swarming with germs. You prick the blister with it—that is, you introduce into a cavity filled with warm solution of albumen the organisms of putrefaction. This is just what the microbes like, and they will rapidly render the contents of the blister putrid. And now neither the microbes nor the matter can escape, for the prick has long ago become obliterated. Nor can you apply anything to kill these germs or promote healing.
The third way to treat a blister is to cut away the whole of the cuticle confining it. This is dead skin, and so removing it causes no harm. You can now apply an antiseptic ointment to the raw surface. The best is an ointment of boracic acid, oil of eucalyptus and vaseline.
Oh, but when you cut open the blister, do you not let the germs in? Yes, you do, unless you have been scrupulously careful that everything you used was perfectly clean. But even if you have introduced germs, it is not so very serious here, for you apply the ointment directly to the raw surface. So now the microbes get the worst of it. There is nothing for them to eat; there is nothing preventing them from getting away; and there is a (to them) poisonous ointment applied directly to them.
We said everything you use must be clean. We must therefore tell you how to sterilise needles, scissors, etc. You are usually told to sterilise instruments by passing them through a flame. Now this has many disadvantages. In the first place, merely passing a knife through a flame does not even warm it. Then, if you leave it in the flame long enough, you spoil its temper and make it dirty with soot.
By far the best way to sterilise instruments is to boil them. Sterilise your needles, etc., by boiling them in solution of carbolic acid in a test-tube.
To treat burns, what must we add to our chest? Boracic acid ointment, that is all.
Now for fractures. If you are taking a drive with a friend, and the horse bolts, and you are both thrown out, but you escape uninjured, while your friend breaks her arm or leg, what are you going to do? You are going to “set” the fracture, are you? Oh, no, you are not! Not if your friend has her wits about her. Have you ever set a fracture before? Have you ever seen a fracture set? Do you know anything about setting a fracture? Of course you do not. You would find that setting a fracture was not the simple thing you think it is.
But wait a minute, we are not yet satisfied that the leg is broken. How do you know that her leg is fractured? If you see the bone protruding, or an angle or lump anywhere between the joints, or if your friend cannot move her leg, or if she can move the upper half but not the lower half, or if she thinks that her leg is broken because she heard a snap, or for other reasons, you may be pretty certain that the leg is broken. You cannot tell for certain, and you must not try to make certain. If you attempt to prove that her bone is broken, you may convert a simple into a compound fracture—a trivial into an extremely serious condition.
But you must do something. Here you are, out on a road, five miles from anywhere, with a friend lying in the road with a broken leg. What are you to do? Splint the leg. For a splint you may use an umbrella, a walking-stick, a branch of a tree, a newspaper strengthened with twigs, or anything that is handy. Place the splint against the limb, and with your own and your friend’s handkerchiefs tie the splint to the leg. Tie it with the handkerchiefs a long way above and below the broken place. Then place your friend on the floor of the conveyance and drive slowly home or to the nearest surgeon.
Upon this emergency-splinting a very great surgeon—let us call him Sir William Sawyer—tells an amusing story. He was walking along a country road, and came across a cart overturned, with one wheel broken, in the middle of the road. A man was lying near the cart. On approaching him the surgeon saw that his thigh was broken. He immediately turned out his pockets and found two old newspapers. Between these two papers he “sandwiched” a good number of twigs, and then wrapped the whole concern about the thigh of the injured man.
When he had done this, he became aware of the presence of a second man, apparently uninjured, staring at him. He therefore bade him go to the nearest village and fetch a surgeon.
When he got to the village, he went to the nearest medical man and asked him to come quickly, for “an old idiot was stuffing his mate with newspapers.” What was the medical man’s surprise to see that the “old idiot” was Sir William Sawyer!
(To be continued.)
[“OUR HERO.”]
A TALE OF THE FRANCO-ENGLISH WAR NINETY YEARS AGO.
By AGNES GIBERNE, Author of “Sun, Moon and Stars,” “The Girl at the Dower House,” etc.