Part 35

General Treatment.—Frequent baths, plenty of fresh air. Temperature of the room should be uniform. Moderate and subdued light.

Diet should consist of nutritious food, liquid or soft, according to the condition of the patient.

The gravity of each case depends largely upon the extent to which the cornea is involved.

Treatment must, of course, be modified according to the virulence of the inflammation.

To Apply a Leech.—Leeches are applied to relieve congestion. Put one in a small vial with a mouth large enough for the leech to crawl through. Cleanse the patient’s temple, and with a sterile needle scratch the skin until the blood shows. Directly over this place the mouth of the vial. The leech will bite almost instantly, and will drop off when it is gorged. If the occasion requires the leech to be taken off before it is gorged, sprinkle a little salt on its head. Hemorrhage should not be checked unless profuse, in which case a piece of ice or alum applied to the spot will arrest the flow. If possible, the patient should be kept in ignorance of the application.

OPHTHALMIA NEONATORUM.

When the disease develops it will be manifested, as a rule, from three to five days after birth by redness of the eye and a slight discharge. It is the duty of the nurse, as well as of the accoucheur, to examine the eyes of the new-born babe each day during the lying-in period, and at the first sign of trouble, if discovered by the nurse, the attention of the physician should be directed to the matter. During the first two or three days after the disease begins there is usually little or no pus present, and comparatively little swelling of the lids, except in the most violent cases. During this so-called first stage the treatment should be that of an ordinary acute catarrhal conjunctivitis—viz.: iced compresses applied for an hour twice a day if the baby is well and strong; gentle flushing of the conjunctival sac with a warm saturated solution of boric acid. As soon as pus begins to form, the eyes must be cleansed more frequently—every hour during the day and every two hours during the night—and the edges of the lids should be kept constantly anointed with sterile vaselin to prevent their agglutination and the retention of the discharge. Drainage is indicated whenever there is suppuration, and if we can prevent the sticking together of the lids in this way, we allow free drainage and reduce the irritation which invariably results from retention of the discharges in these cases.

In all cases it will be noticed that after the discharge has been washed away from the everted lids there are strings or shreds of mucus in the folds of the conjunctiva. The nurse should endeavor at each cleansing to wash them out by continuous flushing and gentle manipulation of the lids. If she does not succeed in keeping the eyes free from these shreds the physician will remove them at least once a day.

If the conjunctiva of the globe becomes swollen and edematous and rolls up over the edge of the cornea, the nutrition of this precious membrane becomes threatened, and inflammation of the cornea, with ulceration or sloughing, is the cause of the blindness which follows this disease. At the slightest indication of haziness of its surface the iced compresses should be discontinued and hot fomentations resorted to. They may be applied every three hours for fifteen minutes each time. Great care and judgment are necessary in order that the heat be sufficient to be effective without burning the delicate skin of the lids and that it be continuous. The compresses should be changed at least every sixty seconds during their application. When the cornea becomes ulcerated great care must be used in the manipulation of the lids not to make pressure upon the eye-ball for fear of causing perforation. If the lids are slippery from the presence of vaselin or discharge, a single thickness of gauze or a little cotton held between the finger and the lid will be found a great help in opening the eye.

As the discharge of pus begins to diminish, which may not be for several weeks in bad cases, we may somewhat modify our treatment; the strong applications need not be quite so strong, and the cleansing need not be quite so frequent; but the most important item in the treatment of all these cases is the frequent thorough cleansing of the eyes, and if the cleansing is thoroughly done as above described each hour and the lids kept constantly anointed, in order to prevent accumulation of the irritating discharge, more frequent cleansing will not be necessary. Great care must also be exercised to prevent much crying by these little patients. They must be kept warm, regularly nursed or fed, and the slightest derangement of the alimentary canal must be attended to. If the cause of the crying cannot be ascertained and removed, it is wiser to soothe the baby with a simple anodyne than to permit the crying to go on.

It should not be necessary to point out the danger which lies in all things which come in contact with the discharge from these eyes.

Blennorrhea neonatorum is responsible for at least 25 per cent. of all the blindness in the world, and yet not one case in a hundred should result disastrously if skilfully and patiently managed.

EMERGENCIES.

HEMORRHAGES.

Hemorrhage from the arteries may be recognized by its bright red color and by the spurting jets by which the blood leaves the wound. Venous (from the veins) hemorrhages flow in a steady stream and are darker in color. Arterial hemorrhage may be checked by firm pressure over the side nearest the heart or above the wound. Venous hemorrhages may be checked by firm pressure on the side distant from the heart or below the wound. Large veins like the jugular should be compressed both above and below the wound because the vein may bleed from both ends. If possible, digital pressure should be made directly over the bleeding point.

Hemorrhage from the leg may be checked by firm pressure upon the femoral artery, in the middle of the groin at the top of the thigh.

Hemorrhage from the forearm by compression under the inner edge of the biceps against the humerus.

Hemorrhage from the upper arm by compression of the axillary artery against the humerus in the axilla.

Hemorrhage from the cheek by compression on the facial artery against the lower jaw just in front of the masseter muscle.

Flexing the limbs at the joints with a pad between them to make the compression secure and then binding the part may prove a successful method of arresting the flow of blood. A constrictor of rubber tubing twisted firmly around the limb is a ready appliance and a most successful way of checking a flow of blood from an injured limb. But it should not remain on longer than absolutely necessary or gangrene may result from complete stoppage of the circulation.

Wounds should be packed fully and evenly with some absorbent material. Applications of heat and cold are common methods of checking hemorrhages, heat being at all times preferable. Hot water poured on open wounds will encourage coagulation. Bleeding from an ulcer of the leg, which often results from varicose veins, should be stopped by firm pressure over the wound.

Hemorrhage from the Lungs.—A teaspoonful of salt taken internally may stop it. Place an ice-bag over the chest. Morphin, gr. ⅛-¼, may be given under the instructions of a physician. In all cases put patient in bed and enjoin complete rest until medical aid arrives.

Nose-bleed (Epistaxis).—First of all, position and rest should be attended to. The patient should not lie down unless very weak. The higher the head the better. Loosen clothing about the neck and thorax. Caution patient against coughing or sneezing. Holding the nostril tightly closed, with cold applications to the back of the neck, is sometimes successful. Insufflation of ice- or alum-water, or of tannic acid solution may induce coagulation. Profuse bleeding will require packing of the nostrils.

FRACTURES.

Compound Open Fracture.—The bone is broken and the wound extends from the seat of the fracture to the outside. Such wound may be caused by the injury itself, or may occur secondarily from the protrusion of pieces of bone through the skin.

A comminuted fracture is one in which the bone is broken into a number of fragments.

An Impacted Fracture.—The broken ends have been forcibly driven into one another, and are thus fixed.

Multiple Fracture.—The bone is fractured at different points, or when different adjoining bones are broken.