CHAPTER I
HOW TO TREAT FRACTURES, SPRAINS AND DISLOCATIONS
EVERAL years ago I stood beside a cot in a hunter’s cabin in the heart of the Bitter Root Mountains in Idaho, after
a three days’ ride, and watched a valuable young life go out as the result of an unat- tended compound fracture of the thigh. At another time I amputated a leg to prevent the spread of gangrene from a simple cut across the instep while the camper was split- ting wood, an accident which, properly treated, would have resulted at most only in a slight inconvenience. Once again, I trans- formed my boat into a funeral barge and conveyed a young man who had only been in
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” the water three minutes back to his sorrow- ing parents dead, because his companions were ignorant of how to resuscitate him.
These and many other instances that have come under my observation of the sacrifice of lives from trivial causes, owing to a lack of knowledge, have impressed me with the value of a few. suggestions on how to treat the commoner injuries and diseases that may befall those who seek recreation in the re- mote wilds.
The rules will necessarily be brief and from the nature of things easily followed. The woods loafer should learn them and be prepared whenever the occasion arises. Works on first aid, written ostensibly for the guidance of the laymen, are apt to presup- pose a far greater supply of surgical neces- sities than the hunter cares to burden him- self with. It is one thing to apply surgical measures, having at hand a well-filled emer- gency bag, and quite another to render the same assistance with nothing to depend upon but your native adaptability. My intention is to tell in the plainest and simplest manner possible how. to render intelligent assistance to an injured comrade, using only the fewest appliances and those of the most primitive
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character. These hints are the result of over twenty years of life in the West, in mining camps, cow. camps, logging camps, and in the heart of the mountains, where people did not have forethought enough to provide themselves with even a bandage, many times hundreds of miles from where such things could be obtained.
The most appalling accident that can be- fall a man isolated from skilled surgical aid is the fracture of a limb, especially of the leg, and yet this is one of the commonest of all woods misfortunes.
Before proceeding to the discussion of in- dividual fractures, a brief consideration of the classification and detection of fractures in general is necessary. Surgeons divide fractures into: simple, those where there is a simple separation of the bone without in- jury to the flesh; compound, where in addi- tion to the separation of the bone there is laceration of the flesh and one or both ends of the bone are driven out through the skin; and comminuted, where the bone is in sev- eral fragments. A comminuted fracture may be either simple or compound, according as it does or does not penetrate the flesh.
The symptoms of fracture are pain, loss
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of motion, change of position, change of contour of the fleshy parts, and most import- ant of all, a light crackling sound when the limb is moved—crepitation the surgeons call it.
Pain following an injury that might pro- duce a fracture is not necessarily proof posi- tive of the existence of a fracture. Pain may and often does follow a bruise, sprain, or dislocation, in a greater degree than that following a fracture. Loss of motion, too, is quite as marked in dislocations and severe sprains as in fractures. Change of contour, unless in the locality of prominent joints, is quite a valuable sign. The fractured limb, except in certain rare cases, will show a change in the appearance of its general out- line.
By crepitation is meant that characteristic grating sound produced by rubbing the two ends of the fractured bone together. It is the one absolute sign of a fracture, and once heard can never be forgotten. It may be likened to the sound produced by rubbing two or three coarse hairs between the finger and thumb.
If a fracture is suspected let the patient himself, or some one for him, grasp the limb
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above and below the site of the suspected fracture and turn it in opposite directions. If a fracture is present it will be manifested by a distinct grating sound, also by a jarring sensation as the uneven fragments pass over each other.
A description of all the fractures of the different bones of the body would be mani- festly out of place in a book of this char- acter, so I shall confine myself to those most liable to be encountered in the woods—that is, fractures of the leg, thigh, forearm, and arm. Fractures of the leg or thigh will en- tail an enforced stay of from four to six weeks in the woods, or the devising of some means to transport the patient to a place where he can have proper care, an arduous task in a country where there are no roads and the trails are difficult. If a personal ex- perience may be allowed, I will tell how I once treated a man with fractured thigh and conveyed him with comparatively little dis- comfort over sixteen miles of rugged moun- tain trail and some forty miles of equally rugged mountain road.
I found the man in a mining camp in the very heart of the higher mountains, lying in his bunk with a badly fractured thigh. The
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bone was separated between the upper and middle third—that is, well up toward the body. The accident had occurred some twenty hours previous and there was much swelling, which it was necessary to reduce before anything else could be done. This was accomplished by the application of cold water by means of strips of blanket, chang- ing the application as fast as the water be- came warmed by the body heat.
In the meantime I went out into the tim- ber and felled a small cedar tree some six inches in diameter. From this I cut a section five feet in length and removed the bark. Splitting the bark in half, I rounded up the edges and made a splint for the outside of the limb extending from the armpit to six inches below the foot. The other half was made into a similar splint, only shorter, for the inside of the limb, extending from well up into the groin to a point opposite the outer splint below the foot.
It was necessary to cut holes in the splints where the bony prominences came. When all was in readiness and the limb reduced in size, I wrapped it well in soft cloth, having no absorbent cotton, and applied my splints. I had a man stand at the feet of the injured
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man, take hold of the injured leg, and pull steadily while I manipulated the fracture.
Right here I want to state that it is unnec- sary to try to pull a broken bone out of the socket in order to set a fracture. A persist- ent pull of some fifty pounds will soon over- come the contraction of the muscles and the bone will be replaced. The acting surgeon must at the same time grasp the limb at the site of the break and knead the two ends into place. You will know when they are in place by the absence of inequality at the point of break.
After the bone had been replaced, I placed my splints in position and bound them on, using strips of sheet torn up for bandages. Any stout cloth will do as well. They may be placed in the ordinary manner, each wrap beside the other, or they may be run on in continuous form, permitting each ascending turn to half overlap the one below it. Care must be taken that the pressure is equal in all parts of the bandage and that it is placed tight enough to prevent any slipping of the splints.
The next problem was to get the man out. Again the cedar forest came to my relief. I felled another and somewhat larger tree,
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sufficiently large to permit placing the in- jured man in a boat-shaped section of the bark. This was made longer than his body and a semi-circular board fitted in each end. When the whole was completed it resembled a rude trough.
This trough was lined with blankets until it was quite soft. Two poles twelve feet in length were lashed to either side and the man securely lashed in the contrivance. ‘When we were ready to start two steady pack animals were brought out and the litter with its burden swung in such manner that the animals could wind down the steep rocky trail with the burden between them. In this manner we jogged down the mountainside all day, our patient laughing and enjoying his pipe as though he were the guest of honor in some triumphal procession.
While cedar was mentioned as having been used in the above case, the reader will appreciate that any sort of timber with a tough bark will answer equally well.
There is one important fact that should always be borne in mind in the treatment of all fractures, and that is that at least the two adjoining joints should be fixed. If it is the thigh that is fractured, the hip, knee, and
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ankle should be included in the splint. If the leg, then the knee and ankle. The same rule holds good with fractures of the fore- arm or arm.
If timber with tough bark is not avail- able, or in open countries where no timber grows, a broken bone may be nicely splinted by using small round sticks. Never use a clapboard unless it is extremely well padded; even then it is undesirable from the fact that it is liable to press upon some bony point and cause trouble. Also it is very lia- ble to slip and permit your fractured bone to become displaced.
To fix a limb by using round sticks, wrap the limb well in soft cloth; then, having cut your sticks the right length, place them at regular intervals about the limb and bind as before. In the absence of anything better, two leather gun scabbards make quite effect- ive splints.
What has been said with regard to frac- tures of the lower limb will apply with equal force to breaks of the upper except, of course, that the case is one of far less grav- ity. In cases of fracture of the arm, either above or below the elbow, the injured per- son can make himself quite comfortable by
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pinning the bottom of his coat to his shoulder and placing the injured arm in the V-shaped sling thus formed.
The treatment of compound fractures is one that requires some ‘“‘nerve’’ on the part of the acting surgeon and a great deal of for- titude in the injured person. A compound fracture of the leg or thigh is the most ter- rible accident, short of death, that can befall a man in the woods. Unless great care is exercised the man will die, either shortly from septic poisoning, or almost immediately from shock.
First, get your patient into camp if he is away from it. That may be done in the fol- lowing manner, which will also illustrate how to carry a person injured in any man- ner: take a blanket and lay it at full length on the ground; place a pole two feet longer than the blanket directly in the center and fold the blanket over it; lay a similar pole in the center of the folded half and fold the free side back over; place your patient on top, and two men can carry him as comfort- ably as though he were in a litter. It is, in fact, an emergency litter.
Another emergency litter may be con-
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structed by buttoning an overcoat its full length and running two poles down the sides, laying the patient between them. Failing an overcoat, two short coats or Mackinaw jack- ets may be made to serve.
Having got your patient with the com- pound fracture into camp, cut off all clothing from the wounded limb, but no more. It is a bad plan to remove too much clothing from badly injured persons. All the warmth must be conserved, even to the extent of ap- plying artificial heat. Examine the wound for foreign matter and carefully remove it, especially bits of clothing, leaves, small sticks, and bits of earth.
While you have been thus engaged, water should be heated in the cleanest, brightest vessel the camp affords. If there are none bright enough, one may be sterilized by burning it over a hot fire for at least ten min- utes. It is absolutely essential that the water used to cleanse a wound of this character should be sterile—that is, without any germ life whatever; hence the directions for boil- ing it.
In another clean vessel boil all the cloths, towels, and other dressings that you intend using. Any soft cloth will do for dressings,
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provided it is sterilized and sterilization con- sists only in thorough boiling.
One of the articles I shall mention in a very limited surgical kit is a bottle of tablets composed of bichloride of mercury known as Bernay’s tablets. They are made by all chemical houses and vary in form, but all contain about the same quantity of the anti- septic agent. Some are white and some blue in color, the blue being preferable.
One of these tablets dissolved in a quart of water makes a solution of about the proper strength for dressing wounds. Make your solution and with your sterilized cloths wash out the wound thoroughly, and that does not mean to let a little water flow over the wound; it means to remove every par- ticle of foreign matter in and about the wound.
If the bones have stuck into the earth, as is quite often the case, they must be exposed and the narrow canal cleaned. Then replace the bones in as nearly their proper position as possible. Do not attempt to “set” the bone; just put it back fairly nearly in line. Then cover with several layers of moist cloth that have been previously boiled and dipped in the bichloride solution.
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Every day expose the wound, wash it out, and dress it. If the patient is of strong physique and God smiles, he may not have septic fever. If, however, the limb shows signs of inflammation evidenced by swelling and redness, accompanied by fever, chills, and thirst, then must you perform some heroic tasks to save your patient's life.
Remove all dressings and wrap in per- fectly clean dressings the entire limb from the hip to the foot, elevate so that it will drain properly, and keep cold water running over it in a small stream constantly. This may be done by making a small hole in the side or the bottom of a bucket and hanging it in such a way that it will permit the stream to fall on the limb. If you follow the fore- going directions implicitly, you have done all that can be done.
It will be understood that what I have said touches upon the subject of fractures in only a very general way. The methods of treatment outlined will apply to prac- tically any fracture, and certainly to those most liable to be encountered in the woods.
The four principal dislocations that are liable to engage your attention are those of the hip, knee, elbow, and shoulder. Of
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these, that of the hip is the most serious. Without going deeply into the classification of hip-joint dislocation, it will be sufficient to say that fortunately by far the greater number of these is where the head of the bone slips out of its socket upward and backward. Those in which the head of the bone occupies other positions with relation to its socket are much more difficult, in fact, for the layman practically impossible.
The signs of a hip-joint dislocation are shortening of the limb, loss of motion, pain, and the turning of the toes in toward the opposite foot. You will be able to distin- guish it from a fracture of the thigh by the absence of crepitation (which I have de- scribed as the slight grating sound made by the broken ends of the bone rubbing to- gether), and the fact that in a fracture the toes are generally turned out.
A friend of mine once reduced his own hip-joint dislocation in a manner that may prove instructive. He was coming down the steep side of a mountain in winter on skees. Halfway down the hill, while he was travel- ing at a great rate of speed, he ran into a depression, breaking his skee and dislocating his hip. It was many miles to the nearest
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cabin, night was coming on, and it was bit- terly cold. Death stared him in the face. It was a time for the exercise of judgment if ever in his life.
He crept down to a grove of small pines, selected two that were just a little farther apart than the length of his body, lashed the foot of the injured limb to one with his pack strap, lay at full length on the snow, and clasped the other with his arms. Pulling with all his might, he had the satisfaction of hearing the bone jolt back into its socket. The idea suggested will enable the reader to modify the method to suit each individual case.
In dislocations of the shoulder the old method still in vogue among some medical men is quite easy of accomplishment. Lay the patient on his back and seat yourself at his side, first having removed the shoe from your foot next to his body. Grasp his in- jured arm and turn it outward from the body. Place your bare foot well up into his armpit. While an assistant steadies his shoul- der, pull downward upon his arm, at the same time moving it toward the patient’s body.
Make your pull steady, and when you have begun do not relax until you feel the
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bone jolt into its position. In the case of muscular persons the pull must be kept up for a longer period, or until the contraction of the muscles has been overcome.
Dislocations of the elbow are usually those in which the two lower bones slip back- ward and the upper bone forward. They may be reduced by grasping the injured arm just above the elbow with your left hand, the fingers just behind the prominence of the dis- location; with the other hand bend the in- jured arm well forward, at the same time slipping your left hand downward.
When the injured arm is fully bent, grasp tightly with your left hand at the elbow joint and with your right forcibly straighten it. The fingers of your left hand form a ful- crum for the bone that is out of place to act upon and thus force it back into position. This maneuver is somewhat difficult to de- scribe but quite easy to accomplish. One will be surprised with what ease the bone slips back into position.
Dislocations of the knee are reduced sim- ilarly, except that it requires two to do the work. Then, too, the knee often becomes dislocated laterally and the pressure must be made in a lateral direction.
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A very distressing little accident is the dis- location of the lower jaw. I once had a patient who rode a long distance with his mouth wide open, suffering a great deal of inconvenience and no little pain, when one of his friends could have relieved him in an instant. Wrap both your thumbs in several layers of cloth, stand behind the patient, who should be seated, and place your thumbs thus protected, on his back teeth, grasp his jaws on either side with your fingers, press down with your thumbs, up with your fin- gers, at the same time drawing the jaw for- ward. The bones will go back with a snap and the victim will spasmodically close his mouth hard enough to draw. blood unless your thumbs are well shielded.
Dislocations of the joints of the fingers may be reduced by taking a double half-hitch around the finger below the dislocation with a handkerchief, placing your left thumb back of the head of the dislocated bone, and as you pull on the handkerchief with your right hand push forward and downward with your left. The bone will readily slip into place.
Dislocations should be kept at rest for sev- eral days and any tendency toward inflam-
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mation kept down by the application of water. Severe dislocations, as those of the hip, should be treated similarly to fractures.
Sprains and bruises, while not serious, are often very annoying. When the accident first occurs immerse the limb in cold spring water. This has a tendency to contract the small blood vessels and keep down inflam- mation. If, however, swelling has already set in,