Backwoods Surgery & Medicine

CHAPTER I. How to Treat Fractures, Sprains and Dislocations

HOW TO TREAT FRACTURES, SPRAINS AND DISLOCATIONS

Several 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 unattended 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 splitting wood, an accident which, properly treated, would have resulted at most only in a slight inconvenience. Once again, I transformed my boat into a funeral barge and conveyed a young man who had only been in the water three minutes back to his sorrowing 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 remote 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 presuppose a far greater supply of surgical necessities than the hunter cares to burden himself with. It is one thing to apply surgical measures, having at hand a well-filled emergency 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 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 befall 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 individual 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 injury to the flesh; compound, where in addition 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 several 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 of motion, change of position, change of contour of the fleshy parts, and most important of all, a light crackling sound when the limb is moved—crepitation the surgeons call it.

Pain following an injury that might produce a fracture is not necessarily proof positive 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 outline.

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 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 manifestly out of place in a book of this character, 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 entail 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 experience may be allowed, I will tell how I once treated a man with fractured thigh and conveyed him with comparatively little discomfort over sixteen miles of rugged mountain 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 bone was separated between the upper and middle third—that is, 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, changing the application as fast as the water became warmed by the body heat.

In the meantime I went out into the timber 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 man, take hold of the injured leg, and pull steadily while I manipulated the fracture.

Right here I want to state that it is unnecessary to try to pull a broken bone out of the socket in order to set a fracture. A persistent pull of some fifty pounds will soon overcome 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, sufficiently large to permit placing the injured 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.

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