– After all injuries which fall short of destroying life there is a natural tendency on the part of the organism to repair the damage done-that is, if the person injured is in good health at the time. If he is not in good health the vital reaction may be so feeble that a small injury may be attended with serious and even fatal results. A crushed finger, which in the case of a healthy person would be well in a few weeks, may in a sickly person refuse to heal at all; gangrene and mortification may follow and spread, and finally death may ensue. But these cases are exceptional. Generally a wound will heal of itself, and all that it is necessary to do is to assist nature to do her work. This may be done in many ways, chiefly by giving support to the part and keeping the wound clean. For a simple and superficial wound the less that is done to it the better. If the serous fluid that exudes from it is allowed to form a crust or scab, healing will take place beneath, and the scab will fail off when the process is complete.
If the superficial wound is over some sharp, bony prominence, as the shin, more care will be needed.
If the scab does not form well, the part should be painted with Collodion (a solution of gun-cotton in chloroform or ether), a gummy kind of liquid which soon sets and forms a good skin over the part. Instead of Collodion the skin of an egg may be used. It should be cut into strips, and laid on the wound with the side next the shell on the wound. Wounds that require treatment are of three principal kinds- (1)incised wounds or cuts; (2) punctured wounds or stabs, as when a nail or knife is run into a part; (3) lacerated wounds, as when the parts are torn and bruised.
Bleeding from Wounds.- All these wounds are apt to give rise to great loss of blood. This only occurs when some considerable vessel-artery or vein-has been injured. If it is an artery the blood will be bright in colour and will come out in jets; if it is a vein the flow will be steady and the colour dark. The arterial bleeding is the most serious, and no time should be lost in summoning medical aid. But those at hand must at once proceed to stop the bleeding. If the bleeding point can be seen, pressure on the spot with the thumb or a small pad will stop it. If the bleeding point cannot be found, tie a handkerchief round the limb tightly just above the wound on the side nearest the heart. This will compress the arteries and prevent the stream of blood passing through. If the artery that beats above the wound can be found, pressure may be made upon that either with the thumb or by a good-sized cork laid along it and firmly secured with the bandage. This will do away with the necessity of constricting the whole of the limb. If the bleeding is dark and venous, a pad must be placed over the bleeding point and firmly secured. A little oozing will do no ham if it soon ceases.
-The wounded limb should be elevated and kept raised up.
The above measures will be chiefly called for in cuts and lacerated wounds.
Punctured wounds are dangerous if they are deep, because there is only a small outlet. All impurities that may have existed on the weapon will be left in the wound, and the effused blood will not be able to escape properly. If inflammation ensues it is often necessary to open the track of the weapon and convert a punctured wound into an incised one.
If the wound has been made with a rusty nail, a splinter, or a piece of glass that cannot be entirely extracted, drop into it daily a little balsam of Peru, or else Canada balsam. The wound will then heal from below. If there is much inflammation apply hypericum oil.
All open wounds must be cleansed by means of forceps, or a stream of water, or both, from all particles of dirt, glass, iron, splinters, or whatever may have got into them. If it is impossible to remove everything do not close up the wound completely, and apply only a light dressing.
In closing a wound there are two objects to be attained-(I) the severed edges of the skin should be brought accurately together, and (2) the deep parts should be supported.
In the case of deep wounds the surgeon will put in deep stitches; in extensive wounds that are not so deep the edges of skin may be brought together with skin-stitches; in less severe wounds strips of adhesive plaster will do all that is necessary. These should be long; they should run at right angles to the cut.
Gentle traction should run at right angles to the cut. Gentle traction should be made on the skin in the direction towards the wound before the strips are fixed. This will prevent any tendency to drawing asunder of the flaps, and make it easier for them to unite. Over the strips may be placed a fold or two of lint to take up any discharge that may ooze from the wound, and over all a bandage is needed to support the limb or part. The dressing must be changed once or twice a day, according to the amount of discharge. If there is none, and the wound is going on well, the dressing need not be changed so often.
Dressings.-In superficial wounds, if the part can be kept at rest till a scab forms no dressing will be needed. If it is necessary to form a protecting covering. Collodion may be painted on, or the skin from an egg-shell, as described above.
For deeper wounds, where there is redness, swelling, and pain, cold water compresses may be applied. They should be covered with oil-silk, and changed frequently. Where there are no signs of inflammation a dry dressing is to be preferred. Calendula ointment is one of the most useful of all dressings. It may be spread on lint and applied over the cut. It will assist the healing, and at the same time prevent the dressing sticking into the wound. A lotion made of one part of the tincture of Calendula to ten of water may be used for cleansing the wound. A good plan is to syringe out the wound with the lotion; a jet may thus be brought to bear on any part. Whilst this is being done the limb should be placed over a large open vessel, or a dressing-tray made for the purpose, to catch the liquid or discharges.
In removing dressings it is necessary to take off the plasters by taking hold of each end and drawing each end off towards the wound. If only one end is taken hold of and the strip is drawn off in one direction for the whole of its length, after it is pulled off as far as the wound it tends to drag the wound open. If the dressing sticks at all it should be thoroughly moistened with warm water before an attempts is made to take it off. When thoroughly moistened it will come off without any difficulty and without giving pain. As soon as the edges of a wound are strongly united any stitches that have been put in may be cut and removed.
Treatment of the Patient.-When a patient has received a wound he should be kept perfectly quiet, and the wounded part should be kept in an elevated position. If fainting occurs it need occasion no alarm. It is often an advantage, as it prevents the patient feeling pain, and greatly lessens the tendency to dangerous bleeding. So long as there is bleeding do not give the patient much drink, and nothing at all warm. A little vinegar and water may be given. During the process of healing rest and light diet must be prescribed.
Medicines.-(Every ten minutes to every two or three hours, according to the urgency of the symptoms.)
-If there are constitutional symptoms, restlessness, fever, dry skin.
-If with restlessness there is great excitement.
-If there has been much loss of blood. If the patient turns blue and becomes convulsed.
Veratrum 3 – Where there is collapse, pinched expression, cold extremities, cold sweat, especially on forehead.
-Punctured wounds, red, sensitive to touch, burning, piercing, stinging pain, spreading redness.
Arsen. 3 – Redness running in stripes from the wound along the limb.
-Where there is much bruising of the tissues. If the wound becomes blue Arnica may be applied locally, but only where there is no break on the skin.
-For lacerated wounds with jagged edges, very painful. Such wounds should be kept moistened with a lotion made with the tincture in the proportion of one part of ten of warm water.
-For cuts, thrusts, bruises and lacerated wounds where the pain is excessive, and where nervous symptoms such as spasms come on. It may be given internally and applied locally as Calendula. See also BED-SORES, BRUISES.