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Treatment of Wounds.The next object is to cleanse the wound. The importance of this measure cannot be overestimated ; the execution of it makes all the difference between a rapid and painless healing of the injury on the one hand, and the formation of matter and other accidents on the other. The exact details for cleansing the wound vary according to the nature and location of the injury. In general, the best plan consists in filling a syringe with clean, cold water, which should then be gently squirted into the cut in all directions. It is often necessary to raise the cut edge of the skin in order to direct the water into the cavities of the wound. This is especially true of wounds of the scalp ; for in such injuries it frequently happens that the scalp is detached from the skull for a considerable distance away from the edge of the cut. If foreign bodies (particles of dirt, pieces of clothing, etc.,) be allowed to remain, the wound will not heal nicely ; it will remain open at some point for a long time and discharge considerable matter ; furthermore, there is, under such circumstances, danger of the occurrence of erysipelas. While we are thus careful to remove all foreign substances from the wound, we must be equally cautious in preventing the introduction of any matters which can injure the tissues. Care should be taken to employ only clean instruments and clean water in handling the injured part; and the hands themselves should be scrupulously cleansed before being allowed to come into contact with the wound. If time can be obtained, it will be well to procure some disinfectant in order to wash the wound, and to employ as a dressing. For this purpose, carbolic acid may be used ; care must be taken, however, not to bring the strong acid in contact with the wound, since it will burn the parts severely. A solution of the acid in water can be employed, one part of the acid to twenty-five or thirty parts of water being about the best proportion. After mixing the acid with the water, the solution should be thoroughly shaken or stirred in order to secure thorough mixture ; otherwise drops of the pure acid may remain in the water and cause a severe burning when applied to the wound. Carbolic acid is objectionable in many respects as a disinfectant for popular use ; many accidents have happened through carelessness or ignorance in substituting the strong acid for the proper solution in water; moreover, it takes time to prepare and thoroughly mix the acid. For these reasons, it is desirable to have some other substance which can be prepared for use more quickly, and which cannot, even in the hurry and excitement consequent upon an accident, be carelessly or ignorantly employed to the patient's disadvantage. The best agent which can be kept on hand for use in the household treatment of wounds, is a solution of several of our best disinfectants which is sold under the name of " Lambert's listerine. " This preparation has come into general use among physicians as a most pleasant, reliable and convenient dressing for wounds. It will keep indefinitely, and hence, may be constantly kept in the house for use in emergencies. This liquid should be diluted with water in washing out fresh wounds, one part of the listerine being mixed with four parts of water. After the wound has been washed out, care should be taken to restore the injured parts, so far as possible, to their natural position and to keep them there. If the edges of a wound are allowed to gape widely, the process of healing will be a slow and tedious one, and will probably be complicated by a profuse production of matter. In order to accomplish this object the edges of the wound should be gently dried with a soft towel. Any blood clots which may lie in the cut or around its edges should be gently and carefully removed. If these seem to be firmly attached, or if they are formed at a point which has recently bled profusely, it will be well not to touch such clots of blood ; for their removal might be followed by a recurrence of the bleeding. The edges of the wound should then be drawn together so far as the nature of the injury permits. To hold them in position surgeons resort to three different measures, which may all be employed in the treatment of the same wound. The first of these measures is the application of stitches. This is a delicate operation, which can moreover be made to inflict considerable injury rather than benefit, if performed by unskillful hands. It is, therefore, advisable for the non-professional bystanders to refrain from any attempt to stitch up the wound, leaving this to the discretion of the surgeon upon his arrival. The second means for closing a wound is the application of sticking-plaster. The best variety of plaster is that which is made for surgical use. This can be applied, however, only by a somewhat practiced hand. The best form for popular use is, perhaps, that which is known as the " Mitchell Novelty " plaster, or a kind which is called Martin's adhesive plaster. One or both of these may be kept in the house for emergencies. If there be nothing at hand except the common " court plaster," or some of the numerous " moisture plasters," these maybe employed until something better can be obtained. This plaster should be cut into strips from one-quarter to one-half of an inch in width, and long enough to secure a firm hold on the skin on either side of the cut. The exact length will of course vary, according to the location of the wound. The vicinity of the injured part is then again cleansed and dried. If the wound be upon the head, or other part of the body covered with hair, the hair should be clipped as closely as possible on both sides of the wound in order to give the plaster an opportunity to adhere to the skin. The strips of plaster should be applied one at a time, usually at right angles to the length of the wound. In order to accomplish this nicely, the edges of the wound should be carefully drawn together and held in position by one person while another applies the plaster. A strip should be applied to the skin on one side of the cut and at one or the other end of the wound, the middle of the strip being held over the injured skin. This is made to adhere upon one side of the cut, and while it is pressed firmly against the skin with one hand, it is gently drawn to the opposite side of the wound. The plaster is then pressed firmly to the skin on the other side of the cut, beginning close up to the opening. After it is attached at this point the remainder of the strip may be spread out and firmly pressed to the skin. A second strip of plaster is then applied in the same way, and so that its edge shall touch that of the first strip. If there be much tendency to gaping of the wound, it will be better to apply the second strip, so that its edge slightly overlaps that of the one already applied. A third strip is then placed in position in a similar manner, and so on until the wound has been closed along its entire length. If the wound be a deep one, or if the edges be not clean cut, it will be well not to close the entire wound, but to leave the lower end of it uncovered; the object of this is to permit the escape of matter and blood which may be formed and ooze into the wound. If the cut be closed along its entire length, and matter should be subsequently formed, the healing process will be retarded, the edges of the cut will swell and fail to unite; by leaving an opening through which the matter can escape, we can at least secure healing for the wound through the greater part of its extent. In such a case it will be advisable not to place the strips of plaster in contact, but to leave spaces between adjacent strips, so that the matter can escape at several points, if necessary. If the wound be not a deep one, no further dressing is required than a simple wet cloth. This may be kept in position by a bandage pinned somewhat tightly around the injured part. If, however, the wound be a deep one, so that it penetrates through the skin and fat into the red flesh beneath, it is necessary to employ the remaining means for keeping the parts in their natural position. This third measure consists in the application of a bandage and compress. By a compress wre mean simply a piece of lint or soft cloth, folded so as to make three or four thicknesses, and wet with cold water. This is laid upon the wound so as to cover the edges and the skin in the immediate vicinity. A stout muslin bandage may then be snugly applied to the limb, so as to exert considerable pressure upon the edges of the wound, though not so tightly as to cause the patient much pain. The fourth object in the treatment of wounds is an effort to secure perfect rest for the injured member. The location of the injury must of course determine just what is necessary in order to keep the part in perfect repose. If the injury has been inflicted upon the lower extremity, the individual should keep the recumbent posture ; if the arm be the seat of the injury, a bandage or sling should be arranged so that the patient cannot thoughtlessly use the arm, or even the fingers. This is an important item of treatment, the neglect of which will retard the process of healing, or even cause the half-healed wound to break out afresh. If the injured member feels perfectly comfortable except for a slight smarting, the dressing need not be changed for a day or two; in fact, if the cut be not deep, a single dressing often suffices, and may be allowed to remain for a week or ten days. If, however, the wound be the source of pain, the bandage and the compress should be removed and fresh ones substituted, the bandage being this time applied somewhat more loosely than before. If the sticking plaster become loosened and the edges of the wound show a tendency to separate, fresh strips should be applied. This is a matter requiring considerable tact and delicacy ; two or three points should never be forgotten. First, each strip should be loosened at both ends, which are then lifted at the same time, so as to separate the plaster from both sides toward the cut, thus detaching the plaster last from the very edges of the wound. The object of this is, of course, to prevent these edges from separating, as will usually occur if we simply loosen the strip at one end and then pull it from the skin. A second point in applying the new strips is, care to put on each fresh strip before the old one lying next to it has been removed ; the strips are, therefore, replaced one by one successively. If we take off all the plaster before applying the fresh strips, the edges of the wound are left without any support and may fall apart. If there is no discharge of matter from the wound, no further dressing will be required than those mentioned. If, on the other hand, matter be formed, it will be necessary to arrange the bandage so that pieces of lint or soft cloths wet with cold water can be kept constantly applied. If the solution of listerine above mentioned be at hand, these cloths may be wet with this liquid instead of simple water. Care must be taken to secure the free discharge of matter from the wound, and to prevent its accumulation in the dressings. For this purpose the dressings (all except the plaster) may be removed two or three times a day - or oftener, if necessary, to keep the wound clean - and the surface should be washed with the listerine solution. A sponge should be wet with this solution and squeezed so that the liquid falls upon and washes the surface. If the edges of the wound be reddened and elevated, there is probably some collection of matter underneath. In this case the wound should be syringed out very gently with the listerine and water. The syringe used for this purpose should be of hard rubber and should be carefully washed and cleansed every time it is used. With this treatment the wound can usually be healed without the occurrence of any untoward accident. It should be remembered that a wound is sometimes the seat of severe inflammation, especially that form which is known as erysipelas. The occurrence of this accident is indicated by a diffuse redness and swelling of the edges of the wound; at the same time the patient usually has a severe chill, or series of chills, followed by a high fever. For a complete description of the disease, the reader is referred to the chapter on erysipelas. Another complication which sometimes follows upon wounds is the occurrence of blood-poisoning - technically called pyæmia. This accident is, however, seldom met with after simple wounds of the flesh, being commonly observed in cases of injury in which a bone has been damaged. 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