CHAPTER XXIII.

TREATMENT OF ACCIDENT CASES.

Under this head are treated those deaths which are the result of accident.

=Specific Treatment of Accidents.=—_Broken Neck_, _Hanging_, _Strangulation._—The mode of death may possibly cause a separation or dividing of the blood vessels of the neck. If this is the case there will remain in the head and face a large amount of blood, which would soon become coagulated, causing a dark bluish turning black discoloration. The treatment then must be to get this blood from the face, so would recommend the common carotid for injection of fluid and the internal jugular vein for the removal of blood.

Raise both the artery and the vein to the surface, and insert the arterial tube in the artery toward the face, and inject a small quantity of fluid in order to cause a pressure on the venous system, then open the vein, insert the drainage tube and begin to remove the blood, and as the blood drains from the drainage tube inject slowly into the artery. This will help to push the blood out of the capillary system and into the blood bottle and thus clear up the face of its discoloration.

In these cases the raising of only one common carotid would hardly suffice, and it would be far better to operate on both carotids to get the best results. For this reason then the circular incision would be the best operation, and perhaps the use of the Y shaped drainage tube. With the Y shaped drainage tube both sides of the face could be injected at the same time, and the blood could be removed from both internal jugular veins, and the operator could not help but get good results. The removal of blood from the internal jugulars in this direct way will relieve the pressure in the capillaries and smaller veins and induce a better circulation to all the immediate tissues.

=Body Severed.=—For these cases one should have a very good idea of the general arterial and venous circulations of the body, for many of the smaller as well as the larger vessels will be cut, necessitating one to tie them off.

If the body is severed below the diaphragm remove and cleanse all the loose and injured organs and tissues, place them in a bucket or pan and cover with fluid. Ligate all the injured arteries and veins in the upper and lower parts.

Inject the lower extremities from inside the abdominal cavity using the common iliac artery, observing the presence of the remaining united arteries and veins, which you can now see, for fluid will leak from them. The lock forceps will enable you to pick them up and with the aneurism needle dissect around the end of the vessel and tie each one tight.

Treat the upper extremity in the same way injecting either from the inside or the outside, according as the severity of the accident may lead you to decide. Inject from the inside upward through the aorta, or from the outside either through the radial, brachial, axillary or carotid.

The trunk may now be sewed together, beginning at the middle of the back. Sew each side up leaving the top open to receive the organs and the tissues which were removed. After these are placed more or less in position sprinkle hardening compound throughout the cavity. Now sew up the front and then place a strong bandage around the body.

=The Arm Severed.=—Clean off the parts, and inject the severed part through the radial towards the hand and by means of collateral circulation through palmar arch, the upper part will be embalmed and the arteries that have been severed disclosed, when they can be tied off. If there is a great leakage through the stub end, and all the arteries can not be tied off, plaster of paris may be put on the stub and then a strong and tight bandage drawn around.

The remaining body can then be injected through the opposite carotid, brachial or femoral, and when the leakages begin to occur at the stub end of the arm they can be found and tied off or if the leakage is too great plaster of paris may be used and a tight bandage placed about the stub end.

After both the arm and the body have been injected the arm can now be sewed on in its natural position, plaster of paris put around and a strong bandage placed around or a splint may be used on both sides.

=The Leg Severed.=—Clean off the parts, and inject the severed part through the large dorsal toward the foot and by means of collateral circulation through the plantar arch, the upper part will be embalmed and the arteries that have been severed disclosed, when they can be tied off. If there is a great leakage through the stub end, and all the arteries can not be tied off, plaster of paris may be put on the stub and then a strong and tight bandage drawn around.

The remaining body can then be injected through the carotid, brachial, axillary, or the opposite femoral and when the leakages begin at the stub end of the leg they can be found and tied off, or if the leakage is too great plaster of paris may be used and a tight bandage placed about the stub end.

After both the leg and the body have been injected, the leg can be sewed on in its natural position, plaster of paris put around and a strong bandage placed around, or a splint may be used on both sides.

=The Head Severed.=—Clean off the parts, and inject the head through the stub end of the carotid artery, and by means of collateral circulation through the circle of Willis, the fluid will leak through the other severed vessels and disclose them, so that they can be tied off. If one side of the face should take more fluid than the other side by this method the other carotid can be injected so as to equalize. It would perhaps be impossible to tie off all the tiny vessels that are severed so plaster of paris may be used to cover the stub end.

To inject the body, the four principle arteries to be tied are the two common carotids and the two vertebrals, besides numerous veins and small vessels. If it is impossible to tie all the severed vessels plaster of paris may be used, and then by injecting either through the brachial, axillary or femoral a thorough injection may be obtained. The stub end of the carotid might also be used for injection, but would not advise it as in most cases we find that it would be hard to get especially if the head were cut off close to the shoulders.

When both the head and the body have been injected, bring the two parts together by using a splint in the vertebral column, and having plastered well together sew the skin. Demi-surgery can be practiced to the fullest extent in this case, with great cosmetic effect.

=The Head Crushed.=—Remove all the coagulated blood and the injured parts of the brain. Cleanse the cavity thoroughly and remould with plaster of paris. Inject the best you can through one or both of the carotid arteries, and complete the injection hypodermically. Inject the rest of the body in the regular way, through one of the carotids raised for the injection of the head. With the practice and use of demi-surgery, all the