Backwoods Surgery & Medicine

by Charles Stuart Moody

In speaking of fractures and dislocations I did not dream it necessary to suggest anything in the way of a surgical kit. The element of instruments other than bandages does not enter largely into the treatment of this class of injuries, and the bandages may be improvised from materials at hand.

In the treatment of such wounds as we shall now take up, however, it will be necessary to carry a few things with which to work. This outfit will be limited in its scope, economy of space being imperative. A convenient instrument roll may be made from a strip of canvas, with a pocket at the bottom and loops for holding instruments. This can be rolled into compact shape when filled and tied with tape.

In the pocket place a card of assorted silk ligature, ranging in size from one to six, half a dozen egg-eyed needles ranging from full to half curve, one yard of oiled silk or an equal amount of gutta-percha tissue, one bottle bichloride of mercury tablets mentioned before, half ounce Squibb's surgical powder in shaker-top can, four ounces absorbent cotton in carton, two yards sterilized cotton gauze sealed, a paper of safety pins and another of common pins, one soft rubber catheter, number 9, one roll adhesive tape two inches wide.

In the loops place one needle-holder (Emmet's), one hypodermic syringe (all metal), one pair straight shears about six inches, two hemostatic forceps (Kelly's), one curved bistoury (small), and one splinter forcep. The metal case for the hypodermic has compartments for small tubes containing the hypodermic tablets. Take one tube each of the following: hydrochlorate cocaine gr. 1/4, morphine sulphate gr. 1/4, strychnine sulphate gr. 1/60. With the foregoing rather limited equipment you will be able to render assistance to a person injured in any of the accidents likely to occur in the woods.

There are a few surgical principles that should be impressed upon your mind before the subject of treatment is taken up. The first and most important of these is that it requires a great deal more loss of blood than is popularly supposed to endanger life. There is no danger from hemorrhage from a vein and but little from any of the smaller arteries.

The free flow of blood from a wound instead of being alarming is the most beneficial thing that can happen. The cleansing power of flowing blood cannot be overestimated and it is cleansing that all wounds require. That brings up a second thought. All serious consequences arising from incised or punctured wounds come from the invasion of bacteria, and all your efforts should be directed against these energetic little gentlemen, either those that have already entered the wound or those that are striving to gain ingress.

A simple cut will, if permitted to seal itself up in its own blood, generally heal without any further interference. The man who puts tobacco, flour, soap, or any other of the popular monstrosities on a wound is little short of a criminal.

While, theoretically, many people know that blood flowing in a steady stream is coming from a vein and that flowing in jets or spurts is coming from an artery, few know how to take advantage of that knowledge. The general rule to make pressure between the heart and the wound in case of a jet and between the wound and the extremity in case of a stream is only good as a general rule; there are exceptions and it is exceptions that make the rule dangerous. There are times when it becomes necessary to reverse the process.

The proper way is to make compression with your fingers until you have located the region the blood comes from; then apply your steady compression in that locality. There are a few great arterial trunks that lie near the surface and may become injured, the injury causing death from hemorrhage. The manner of locating the compression point for these arteries will be given.

The first of these is the great artery that runs down the inside of the leg, called the femoral. Bleeding from this vessel will result in death in a very few minutes, and it has been known to be severed by a man falling on his sheath knife. The bleeding may be controlled by grasping the leg with the fingers near the body. About half way down the inner surface of the leg the fingers will fall into a slight depression, at the bottom of which lies the femoral artery.