Chapter XLIII (3)

2686. Class 1. _Incised wounds or cuts_.--The danger arising from these accidents is owing more to their position than to their extent. Thus, a cut of half an inch long, which goes through an artery, is more serious than a cut of two inches long, which is not near one. Again, a small cut on the head is more often followed by dangerous symptoms than a much larger one on the legs.--_Treatment_. If the cut is not a very large one, and no artery or vein is wounded, this is very simple. If there are any foreign substances left in the wound, they must be taken out, and the bleeding must be quite stopped before the wound is strapped up. If the bleeding is not very great, it may easily be stopped by raising the cut part, and applying rags dipped in cold water to it. All clots of blood must be carefully removed; for, if they are left behind, they prevent the wound from healing. When the bleeding has been stopped, and the wound perfectly cleaned, its two edges are to be brought closely together by thin straps of common adhesive plaster, which should remain on, if there is not great pain or heat about the part, for two or three days, without being removed. The cut part should be kept raised and cool. When the strips of plaster are to be taken off, they should first be well bathed with lukewarm water. This will cause them to come away easily, and without opening the lips of the wound; which accident is very likely to take place, if they are pulled off without having been first moistened with the warm water. If the wound is not healed when the strips of plaster are taken off, fresh ones must be applied. Great care is required in treating cuts of the head, as they are often followed by erysipelas taking place round them. They should be strapped with isinglass plaster, which is much less irritating than the ordinary adhesive plaster. Only use as many strips as are actually requisite to keep the two edges of the wound together; keep the patient quite quiet, on low diet, for a week or so, according to his symptoms. Purge him well with the No. 2 pills (five grains of blue pill mixed with the same quantity of compound extract of colocynth; make into two pills, the dose for an adult). If the patient is feverish, give him two tablespoonfuls of the fever-mixture three times a day. (The fever-mixture, we remind our readers, is thus made: Mix a drachm of powdered nitre, 2 drachms of carbonate of potash, 2 teaspoonfuls of antimonial wine, and a tablespoonful of sweet spirits of nitre in half a pint of water.) A person should be very careful of himself for a month or two after having had a bad cut on the head. His bowels should be kept constantly open, and all excitement and excess avoided. When a vein or artery is wounded, the danger is, of course, much greater. Those accidents, therefore, should always be attended to by a surgeon, if he can possibly be procured. Before he arrives, however, or in case his assistance cannot be obtained at all, the following treatment should be adopted:--Raise the cut part, and press rags dipped in cold water firmly against it. This will often be sufficient to stop the bleeding, if the divided artery or vein is not dangerous. When an artery is divided, the blood is of a bright red colour, and comes away in jets. In this case, and supposing the leg or arm to be the cut part, a handkerchief is to be tied tightly round the limb _above_ the cut; and, if possible, the two bleeding ends of the artery should each be tied with a piece of silk. If the bleeding is from a vein, the blood is much darker, and does not come away in jets. In this case, the handkerchief is to be tied _below_ the cut, and a pad of lint or linen pressed firmly against the divided ends of the vein. Let every bad cut, especially where there is much bleeding, and even although it may to all appearance have been stopped, be attended to by a surgeon, if one can by any means be obtained.

2687. Class 2. _Lacerated or torn wounds_.--There is not so much bleeding in these cases as in clean cuts, because the blood-vessels are torn across in a zigzag manner, and not divided straight across. In other respects, however, they are more serious than ordinary cuts, being often followed by inflammation, mortification, fever, and in some cases by locked-jaw. Foreign substances are also more likely to remain in them.--_Treatment_. Stop the bleeding, if there is any, in the manner directed for cuts; remove all substances that may be in the wound; keep the patient quite quiet, and on low diet--gruel, arrowroot, and the like; purge with the No. 1 pills and the No. 1 mixture. (The No. 1 pill: Mix 5 grains of calomel and the same quantity of antimonial powder, with a little bread-crumb, and make into two pills, which is the dose for an adult. The No. 1 mixture: Dissolve an ounce of Epsom salts in half a pint of senna tea. A quarter of the mixture is a dose.) If there are feverish symptoms, give two tablespoonfuls of fever-mixture (see above) every four hours. If possible, bring the two edges of the wound together, _but do not strain the parts to do this_. If they cannot be brought together, on account of a piece of flesh being taken clean out, or the raggedness of their edges, put lint dipped in cold water over the wound, and cover it with oiled silk. It will then fill up from the bottom. If the wound, after being well washed, should still contain any sand, or grit of any kind, or if it should get red and hot from inflammation, a large warm bread poultice will be the best thing to apply until it becomes quite clean, or the inflammation goes down. When the wound is a very large one, the application of warm poppy fomentations is better than that of the lint dipped in cold water. If the redness and pain about the part, and the general feverish symptoms, are great, from eight to twelve leeches are to be applied round the wound, and a warm poppy fomentation or warm bread poultice applied after they drop off.

2688. Class 3. _Punctured or penetrating wounds_.--These, for many reasons, are the most serious of all kinds of wounds.--_Treatment_. The same as that for lacerated wounds. Pus (matter) often forms at the bottom of these wounds, which should, therefore, be kept open at the top, by separating their edges every morning with a bodkin, and applying a warm bread poultice immediately afterwards. They will then, in all probability, heal up from the bottom, and any matter which may form will find its own way out into the poultice. Sometimes, however, in spite of all precautions, collections of matter (abscesses) will form at the bottom or sides of the wound. Those are to be opened with a lancet, and the matter thus let out. When matter is forming, the patient has cold shiverings, throbbing pain in the part, and flushes on the face, which come and go. A swelling of the part is also often seen. The matter in the abscesses may be felt to move backwards and forwards, when pressure is made from one side of the swelling to the other with the first and second fingers (the middle and that next the thumb) of each hand.

MEDICAL MEMORANDA.

2689. ADVANTAGES OF CLEANLINESS.--Health and strength cannot be long continued unless the skin--_all_ the skin--is washed frequently with a sponge or other means. Every morning is best; after which the skin should be rubbed very well with a rough cloth. This is the most certain way of preventing cold, and a little substitute for exercise, as it brings blood to the surface, and causes it to circulate well through the fine capillary vessels. Labour produces this circulation naturally. The insensible perspiration cannot escape well if the skin is not clean, as the pores get choked up. It is said that in health about half the aliment we take passes out through the skin.

2690. THE TOMATO MEDICINAL.--To many persons there is something unpleasant, not to say offensive, in the flavour of this excellent fruit. It has, however, long been used for culinary purposes in various countries of Europe. Dr. Bennett, a professor of some celebrity, considers it an invaluable article of diet, and ascribes to it very important medicinal properties. He declares:--1. That the tomato is one of the most powerful deobstruents of the _materia medica_; and that, in all those affections of the liver and other organs where calomel is indicated, it is probably the most effective and least harmful remedial agent known in the profession. 2. That a chemical extract can be obtained from it, which will altogether supersede the use of calomel in the cure of diseases. 3. That he has successfully treated diarrhoea with this article alone. 4. That when used as an article of diet, it is almost a sovereign remedy for dyspepsia and indigestion.

2691. WARM WATER.--Warm water is preferable to cold water, as a drink, to persons who are subject to dyspeptic and bilious complaints, and it may be taken more freely than cold water, and consequently answers better as a diluent for carrying off bile, and removing obstructions in the urinary secretion, in cases of stone and gravel. When water of a temperature equal to that of the human body is used for drink, it proves considerably stimulant, and is particularly suited to dyspeptic, bilious, gouty, and chlorotic subjects.

2692. CAUTIONS IN VISITING SICK-ROOMS.--Never venture into a sick-room if you are in a violent perspiration (if circumstances require your continuance there), for the moment your body becomes cold, it is in a state likely to absorb the infection, and give you the disease. Nor visit a sick person (especially if the complaint be of a contagious nature) with _an empty stomach_; as this disposes the system more readily to receive the contagion. In attending a sick person, place yourself where the air passes from the door or window to the bed of the diseased, not betwixt the diseased person and any fire that is in the room, as the heat of the fire will draw the infectious vapour in that direction, and you would run much danger from breathing it.

2693. NECESSITY OF GOOD VENTILATION IN ROOMS LIGHTED WITH GAS.--In dwelling-houses lighted by gas, the frequent renewal of the air is of great importance. A single gas-burner will consume more oxygen, and produce more carbonic acid to deteriorate the atmosphere of a room, than six or eight candles. If, therefore, when several burners are used, no provision is made for the escape of the corrupted air and for the introduction of pure air from without, the health will necessarily suffer.

LEGAL MEMORANDA.