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Wounds.It is a fact that the natural tendency of healthy flesh is to heal a wound without the formation of matter or the occurrence of any untoward accident. There is no difference in this respect between the slight cuts which everyone receives occasionally, and the more severe and dangerous wounds. If the individual be in good health, and be free from constitutional taint, the natural course of a wound is toward immediate and perfect recovery. We are all familiar with the fact that a simple cut with a penknife usually heals without any difficulty or danger to the patient; yet it sometimes happens that death results from an apparently trifling injury of this kind. So, too, severe and extensive wounds are usually supposed to heal less readily and safely ; yet the fact is that patients have recovered from the most severe and dangerous injuries as nicely and easily as from the cut of a penknife. Many instances are on record in the annals of surgery in which recoveries have occurred from the most frightful injuries. One of the most famous of these is the well-known case which occurred some years ago in New England, in which a heavy iron bar - a so-called " tamping iron " - was driven by a premature explosion of blasting powder, clear through the head of one of the workmen ; yet the man recovered perfectly without serious trouble. So, too, instances are known in which persons have been literally disembowled, the abdomen being ripped up by sabres, bayonets razors, the horns of enraged cattle, etc., so that the intestines protruded ; yet such wounds too may heal as quietly and nicely as the more trivial ones. The difference between the rapid and uninterrupted healing of a wound on the one hand, and the interruption of the process by the formation of matter, the occurrence of erysipelas and other accidents on the other, is usually the result of the manner in which the wound is cared for and treated. There are, of course, instances in which organs of vital importance are injured, or in which the location of the wound prevent the execution of proper principles of treatment; in such instances it is often impossible for the surgeon to carry out those measures which he knows to be necessary for the rapid healing of the wound; since, in order to do so, he would run the risk of injuring important organs, the damage to which might destroy the patient's life. A most important revolution in the treatment of wounds has marked the progress of surgery in the last twenty years. It was formerly expected that the wound left by the amputation of a leg, for instance, would heal only after several weeks, and after a good deal of matter had been formed. At the present time, on the other hand, surgeons expect such wounds to heal far more rapidly, and without the formation of matter to any considerable extent; if the case does not progress so favorably as this, the blame usually rests with the surgeon, providing, of course, the patient is in good condition, and the limb was healthy at the point of amputation. It is not necessary to enter into any detailed discussion of the methods employed by surgeons in the treatment of wounds. Certain general principles, however, must be mentioned, which can be understood and applied by any one without the experience, practice and skill which belong to the surgeon. We may formulate these principles, which apply to the treatment of all wounds, in the following way : First.-Stop the bleeding. Second. - Cleanse the wound thoroughly from all foreign matter as well as from blood clots, unless these are necessary to prevent bleeding. Third.-Restore the parts to their natural position so far as possible. Fourth.-Keep the wounded member perfectly quiet. In order to stop the bleeding it becomes necessary, of course, to prevent the blood from flowing to the surface of the wound. The exact method for accomplishing this may vary somewhat in different cases ; but in general it may be said that we can temporarily check the bleeding at once by compressing the edges of the wound. Thus if the scalp be wounded by a knife, there will occur a profuse flow of blood which may in a short time obscure the wound and be sufficiently profuse to render the patient faint. In these cases we can at once stop the bleeding partially or completely by simply compressing the edges of the wound. So in general we may control the bleeding, to a certain extent, by simple pressure ; if the wound be in a soft part the pressure should be exerted by taking hold of the bleeding edge with the Angers and compressing the severed blood vessels in this way. Cuts about the head are especially troublesome for the non-professional to manage, for several reasons: first, because the scalp is richly supplied with blood vessels and the bleeding is consequently apt to be very profuse. The appearance of an individual, who has received even a slight scalp wound, is apt to be unpleasant and terrifying in the extreme ; for the blood streams down over the face, giving the person an unnatural and alarming appearance, and the clotting of the blood in the hair conveys the impression that the injury is really quite extensive. Another difficulty is the trouble in finding the actual extent of the wound, since it is concealed by the hair. It will usually be found, after the blood is washed off and the hair has been clipped away, that the injury is really far less extensive than was supposed ; for a comparatively slight wound in the scalp is usually followed by considerable hemorrhage. The next measure to be taken in arresting the flow of blood is to tie the bleeding vessels. This operation should be left to the surgeon, unless the bleeding is very profuse and cannot be arrested by pressure. If it become absolutely necessary to take some additional measures other than compression, for the stoppage of the bleeding, it will be best to bathe the cut surface with ice-cold water or with very hot water. The latter is sometimes remarkably efficient in stopping the bleeding. If the blood still flow, a piece of soft cloth should be folded into a pretty firm mass, wet with water and inserted into the wound in such a way as to cover the surface where the bleeding is most profuse ; pressure may then be made upon this for a few minutes, at the end of which time the bleeding has usually ceased. This folded cloth will be still more efficient in controlling the escape of blood if it be sprinkled over with powdered tannin or alum ; these agents act as astringents-that is, they have a tendency to close the cut ends of the vessels. If the wound be located on the arm or leg, the bleeding can often be stopped without applying any astringents directly to the injured surface. It is always better to keep everything out of the wound (except water) until the surgeon's arrival ; for the healing of the wound is apt to be delayed by the presence of substances which are introduced after the wound itself has been made. If the injury be located in the arm or leg, it will be well to compress, not the edges of the wound itself, but the limb at some point between the wound and the body. For the blood goes into the arms and legs through large blood vessels - arteries - the location of which can be easily ascertained ; and by compressing these arteries we shut off the flow of blood to the entire limb, and, of course, stop the bleeding from the wound. The large artery which supplies most of the blood to the lower extremity passes from the trunk to the limb quite near the front surface of the body. If we place a finger upon the skin of the groin about halfway between the bony prominence of the hip-bone and the inner surface of the thigh where it joins the body, we can usually feel, upon slight pressure, the beating of the artery. In fact, unless the individual be somewhat fleshy, the regular rise and fall of the skin can be distinctly seen when the person is bared. In case of a wound in the lower extremity we can, therefore, arrest the flow of blood by firm pressure upon the artery just at the fold of the groin. If for any reason it be impracticable to employ this means of compressing the vessel, the same result can be attained, though less neatly and completely, by tying a cloth around the thigh. Some soft material, such as a large folded handkerchief or towel, should be employed for this purpose, since it will be necessary to tie the limb tightly, an operation which will injure the skin if such hard materials as rope be used. The best place for compressing the limb in this way is about four inches above the knee-pan, where the artery lies close to the thigh-bone. In case of bleeding from a limb, benefit will be derived by keeping the limb elevated, since the flow of blood will naturally be diminished by such position. The artery which supplies the blood to the arm passes from the body across the armpit just below the head of the bone of the arm. This artery may be compressed most advantageously at a point about one-third of the way from the shoulder to the elbow. By pressing the fingers firmly against the side of the arm next to the body at this point, we may feel the beating of the artery. Firm pressure against the bone of the arm will arrest the flow of blood through the vessel and stop the bleeding at any point below. It will usually be advisable, however, to tie a towel tightly around the arm, since this limb is not so fleshy as the thigh, and pressure exerted in this imperfect way is usually quite sufficient to stop the bleeding. If for any reason the arm cannot be compressed at this point; if, for example, the wound extend almost or quite to the shoulder, there is still another way for arresting the bleeding by pressure, for the artery which goes to the arm passes across the front of the chest just behind the collar-bone; in this position it lies above the first rib. We can, therefore, compress the vessel by exerting pressure against the first rib just behind the collar-bone, near the point of the shoulder. This can be done with the thumb or by means of a large door-key, which should be first wrapped with a handkerchief in order not to injure the skin. Additional advantage in checking the flow of blood is obtained, if the wound be situated below the elbow or below the knee, by bending the arm firmly at the elbow or the leg firmly at the knee. In this way the artery is compressed, since it runs across the joint in such a way as to be pressed by this position of the limb. A bandage may then be put around the arm or leg so as to hold it firmly in this bent position. It should be remembered that the flow of blood is necessary to the life and welfare of the tissues composing a limb ; hence it is not advisable that a bandage which cuts off the flow of blood to the entire arm or the entire leg should be allowed to remain more than an hour; it will be much better to remove it before the expiration of this time, and to observe whether the blood still flows from the wound. By the means thus described, bleeding may be checked from all wounds of the extremities ; but wounds in the palm of the hand or sole of the foot are especially dangerous, and should never be permitted to go without the advice of a surgeon. For the arrangement of the blood vessels in these parts of the body is peculiar; and an injury to the arteries at these points may result in the loss of the hand or foot, even though the bleeding apparently ceases for a short time after the use of the measures already indicated. It is often necessary in the treatment of such wounds to perform an operation whereby the leading artery can be tied higher up in the arm or leg. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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