Health on the Farm: A Manual of Rural Sanitation and Hygiene

by H. F. Harris

As soon as all bleeding has ceased, the wound should be thoroughly washed out by means of water that has been boiled and allowed to cool; the operation may be greatly assisted by using a rag or a piece of cotton that was boiled in the water. If there be grease or other dirt that does not readily come away soap may be freely used.

After the wound has been thoroughly cleansed, some sort of antiseptic had better be applied. Unquestionably the best of all of these is tincture of iodine, a small amount of which should be poured directly into the wound. A saturated solution of carbolic acid in water is also a fairly good disinfectant, and may be employed where the tincture of iodine cannot be obtained. A solution of corrosive sublimate in water—one part of the former to one thousand parts of the latter—is much used as an antiseptic by surgeons, but when placed directly in wounds has a tendency to cause much irritation, and is by no means so efficient as either of the disinfectants just referred to. In the country it is an old custom to use turpentine, or resins from several different species of pines; these are fairly efficient antiseptics, and should be employed where it is impossible to obtain those that are better. It should always be remembered that thorough washing out with boiled water and soap is in itself a procedure that will remove a considerable proportion of any germs that may have got into the wound, and that if carefully done, it is almost as efficient as the best antiseptic.

After the wound has been thoroughly cleansed by water and antiseptics, it should then be bandaged with a cloth that has been previously boiled and dried, if no regular surgical dressing is at hand. Every precaution should then be taken to prevent it being reopened. Collodion is sometimes used over small wounds, and is quite efficient in that it forms a coating over any surface upon which it is placed that is impermeable to both air and water. Small wounds that have been thoroughly cleansed and disinfected with tincture of iodine may be safely and satisfactorily closed by means of the substance just mentioned, but it should never be forgotten that the germ of lockjaw—which is the one, ordinarily, most to be dreaded in such injuries—lives and grows best in the absence of the oxygen of the air, and that a covering of collodion would materially assist in the development of this dreadful disease.

In those instances where pus forms in wounds, they should be at once reopened and allowed to drain. It very often follows after cuts—particularly if they be not properly cleansed—that a scab forms on the outside, holding beneath a greater or less amount of pus. The presence of the latter can generally be inferred by a wound presenting a red and angry appearance around its edges, and from swelling and pain. As soon as such a condition is observed, the scab should be thoroughly soaked in water and removed, and it is then necessary that the wound be kept open and allowed to drain freely until it heals up from the bottom. A failure to observe precautions of this kind may result in blood-poisoning, and finally even in death. After a wound begins to suppurate it does little good to put antiseptics into it, as they cause considerable irritation, and under no circumstances do they put an end to the pus formation. Open drainage of the wound, and keeping up the general health of the patient, are the only means that we possess of successfully combating conditions of this kind.

Inasmuch as we possess an antitoxin that unquestionably has the power of preventing lockjaw, if given sufficiently early, it is the part of wisdom to administer at once a sufficient dose of this substance to any child who has received a penetrating wound from some dirty object, or from the explosion of fire-crackers. Statistics show that under such circumstances lockjaw may be prevented in almost all cases. If we wait until the disease develops, the antitoxin is of no value.

Care of Sprains.—The seriousness of sprains is very generally underestimated, and as a consequence many persons go through life with ankles that are abnormally weak, and even painful in bad weather, and in which there is a tendency to swell and become exceedingly troublesome after a slight wrench. In all true sprains there is more or less actual tearing of the ligaments that bind the joint together, and, if the injury be not properly treated and the joint thoroughly supported, complete recovery in many instances never takes place.

As soon as a sprain occurs the injured joint should be immersed in water just as warm as can be borne, and hot water should be from time to time added in order to keep the temperature sufficiently high. The bath should be continued for several hours—the longer the better. Thus the pain and swelling will be greatly reduced, and the tenderness which, in the beginning, is so excruciating, will largely disappear. The next step is to properly support the injured parts in order that unnecessary movement may be prevented, thus avoiding further tearing of the ligaments. This may be accomplished by means of various splints—the most popular being those made of plaster of Paris, or silicate of sodium, either of which will require the services of a physician in order to have them properly applied.

Within recent years a treatment has come much into vogue, which is exceedingly satisfactory, and has the advantage that it does not require the service of an expert in order to have it properly carried out. This consists in the application of strips of adhesive plaster to the skin over the seat of the injury and for some distance both above and below the joint affected. Ordinary sticking-plaster is not the best for this purpose, though in an emergency it might be used; much better is the so-called mole-skin plaster, which is much thicker, and does not require moistening before being applied. The plaster should be torn into strips about three-fourths of an inch wide and twelve to eighteen inches long. Where the ankle is the seat of the trouble, a strip is firmly applied to the back of the foot, beginning just behind the toes, and is brought around the ankle and carried up on to the calf of the leg—thus partially winding the plaster around the leg. The first strip having been applied, another is put on in a similar way, the edges of the latter overlapping those of the former. This is continued until one side of the ankle is fairly well covered, after which we may begin operations on the opposite side, carrying the strips around the leg in such a way as to meet and overlap those first put on. This process is continued until the entire joint is completely covered with the plaster. It is of the utmost importance that the foot be put in a natural position before we begin to apply the plaster, as, otherwise, it will be left in a constrained and uncomfortable position, which will do away largely with the good effects of the splint. Where carried out in the proper way it is in the highest degree astonishing to see how perfectly the joint is supported, with the effect that the use of the injured limb may be immediately resumed. The writer recalls having seen a young lady with a frightful sprain, who could not bear to touch her foot to the floor, improve to such an extent under the treatment as outlined that she was able to go to a ball and dance through the evening on the day the injury occurred.

Not only does the immediate resuming of the use of an injured limb, when treated in this way, appear not to be injurious, but the ultimate recovery seems actually hastened. After a day or so it is well to remove the plaster splint first applied and put on another, as the former has by this time usually ceased to fit the injured joint—owing to the diminution in the swelling. The splint may be changed three, four, or even five times, if deemed necessary, though two or three applications generally amply suffice. This or some other splint should be kept on the injured joint for at least a month or six weeks, as otherwise complete recovery frequently fails to occur, with the permanent weakening of the joint as a consequence.

Of course it is always desirable to have a physician apply the splints for a sprain where this is feasible, but with a little care it may be done by any intelligent person who will observe closely the directions given. The plaster should be put on moderately tight, but the utmost care must be exercised in not carrying this to an extreme, as in such cases serious results might ensue. In order that it may be determined as to whether or not the splint is too tight, it is advisable to watch the patient's toes for some hours after the plaster is put on, and should they be found to be very cold, and particularly should they begin to show a dusky discoloration, it is evidence that the strips are exerting too much pressure, and they should be at once removed. Under such circumstances, in a half an hour or so, the splint could be reapplied with safety.