First Aid Rule 1.—Apply water as hot as hand can bear.
Rule 2.—Elevate the part, and drench with carbolic solution (one teaspoonful of carbolic acid to one pint of hot water).
Rule 3.—Bandage snugly while wet.
Rule 4.—Keep patient warm with hot-water bottles.
GENERAL OOZING happens in the case of small wounds or from abraded surfaces, and is caused by the breaking of numerous minute vessels which are not large enough to require the treatment recommended for large arteries or veins. It is rarely dangerous, and usually stops spontaneously. When the loss of blood has been considerable, so that the patient is pale, faint, and generally relaxed, with cold skin, and perhaps nausea and vomiting, he should be stripped of all clothing and immediately wrapped in a blanket wrung out of hot water, and then covered with dry blankets. Heat should also be applied to the feet by means of hot-water bags or bottles, with great care not to burn a semiconscious patient's skin. The head should be kept low, and two tablespoonfuls of brandy, whisky, or other alcoholic liquor should be given in a half cup of hot water by the mouth, if the patient can swallow. If much blood has been lost a quart of water, as hot as the hand can readily bear, and containing a teaspoonful of common salt, should be injected by means of a fountain syringe into the rectum.
Somewhat the condition just described as due to loss of blood may be caused simply by shock to the nervous system following any severe accident, and not attended by bleeding. The treatment of shock is, however, practically the same as that for hemorrhage, and improvement in either case is shown by return of color to the face and strength in the pulse. Bleeding is apt to be much less in badly torn than in incised wounds, even if large vessels are severed, as when the legs are cut off in railroad accidents, for the lacerated ends of the vessels become entangled with blood and favor clotting.
LOCKJAW.—In the lesser injuries, where bleeding is not an important feature, and in all wounds as well, after bleeding has been stopped, the main object in treatment consists in cleansing wounds of the germs which cause "matter" or pus, general blood poisoning, and lockjaw. The germs of the latter live in the earth, and even the smallest wounds which heal perfectly may later give rise to lockjaw if dirt has not been entirely removed from the wound at the time of accident. Injuries to the hands caused by pistols, firecrackers, and kindred explosives, seem especially prone to produce lockjaw, and fatalities from this disorder are deplorably numerous after Fourth-of-July celebrations in the United States.
The wounds producing lockjaw usually occur in children who explode blank cartridges in the palm of the hand. In this way the germs of the disease are forced in with parts of the dirty skin and more or less of the wad from the shell. Since lockjaw is so frequent after these accidents, and so fatal, it is impossible to exert too much care in treatment. The wound should at once be thoroughly opened with a knife to the very bottom, under ether, by a surgeon, and not only every particle of foreign matter removed, but all the surrounding tissue should be cut out or cauterized. In addition, it is wise to use an injection under the skin of tetanus-antitoxin, to prevent the disease. Proper restriction of the sale of explosives alone will put a stop to this barbarous mode of exhibiting patriotism.
Treatment.—It is not essential to use chemical agents or antiseptics to rid wounds of germs and so secure uninterrupted healing. The person who is to dress the wound should prepare to do so at the earliest possible moment after giving first aid. He should proceed promptly to boil some pieces of absorbent cotton, as large as an egg, together with a nail brush in water. Some strips of clean cotton cloth may be used in the absence of absorbent cotton. The boiling should be conducted for five minutes, when the basin or other utensil in which the brush and cotton are boiled should be taken off the fire and set aside to cool. Then the attendant should scrub his own hands for five minutes in hot water with soap and brush.
He next takes the brush, which has been boiled, out of the water and cleans the patient's skin for a considerable distance about the wound. When this is done, and the water and cotton which have been boiled are sufficiently cool, the wound should be bathed with the cotton and boiled water until all foreign matter has been removed from the wound; not only dirt which can be seen, but germs which cannot be seen. Some of the boiled cotton cloth or absorbent cotton, wet as it is, should be placed over the wound and the whole covered by a bandage. Large gaping wounds are of course more properly closed by stitches, but very deep wounds should be left partly open, so that the discharge may drain away freely. Small, deep, punctured wounds are not to be closed at all, but should be sedulously kept open by pushing in strips of boiled cotton cloth, in order to secure drainage.