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Treatment Wounds

healing, wound, process, antiseptic, tissue and materials

WOUNDS, TREATMENT OF.—Cleanliness is the first essential in the treatment of open wounds of any kind. They must be most carefully guarded against contact with dirty objects, such as handkerchiefs, rags, clothing, soiled fingers, etc. Only perfectly clean, boiled water, or some antiseptic solution may be used for cleansing them. The fingers should not touch a wound until the hands have been thoroughly disinfected.

For some time after bleeding has stopped, all cut-wounds discharge a serous fluid which aids in the healing process. Only absorbent materials, such as cotton, lint, etc., should be used for dressing a wound. Various antiseptics (iodoform, corrosive sublimate, boracic acid, etc.) are of service in protecting the wound, as they prevent the development of bacteria that may have entered. They also avert decomposition. Such remedies as arnica, various herbs, cobwebs, urine, court-plaister, gummed paper, etc., are useless and harmful.

A study of the process by which wounds are healed has demonstrated the fact that the functions of repair reside in the body ; and the better the wound is protected against harmful influences (bacteria), the quicker does the healing process advance. For this reason, wounds should be dressed with germ-free (aseptic) materials after they have been thoroughly cleaned, or with germ-destroying (antiseptic) materials if they show signs of having already become contaminated. The removal of bullets, splinters, or other foreign bodies that may have entered the flesh, should be effected under modern antiseptic precautions. To attempt to remove such objects by exerting pressure on the parts, or by digging with dirty needles, pen-knives, etc., does more harm than good. Nothing hut aseptic instruments and antiseptic dressings should be allowed to come in contact with a wound, in order that inflammation and suppuration may be warded off, and the natural curative efforts of the body aided. The great success of modern surgery is due to the strict observance of these rules, which has made it possible to prevent dangerous wound-diseases and to perform operations which formerly were impossible.

The process of healing may take place either by first intention or by second intention. The former term refers to the healing of wounds in which inflammation and suppuration have not taken place, and in which the natural healing powers of the body are sufficient to effect a cure. The skin is not only a protective covering for the underlying tissues, but also a mechanism for the healing of wounds. In the case of small, clean wounds, the blood, clotting on the surface, forms a protective covering beneath which the healing process can go on undisturbed. This is a matter of daily observation in the case of simple cuts. If the wound is large, and the severed edges of the skin have become widely separated, Nature may be assisted by having the edges sutured together under antiseptic precautions. If this be not done, a tedious process of new tissue formation ensues, and a disfiguring scar frequently results.

When the process of healing has been disturbed, or prevented by the entrance into the wound of poisonous bacteria, inflammation and suppuration are the result. These disturbances are usually accompanied by local pain and by more or less fever (wound-fever). A loss of tissue likewise results, and healing is retarded, often for a considerable period. The wound-edges are not agglutinated by coagulated blood, but are gradually brought together by new fibrous tissue (granulation tissue) ; and a broad, ugly scar remains when the wound is finally healed. In the cases of such suppurating wounds, antiseptic dressings, which must be changed at regular intervals by a physician, are necessary to arrest the inflammatory process and to aid Nature in overcoming the bacterial infection. These disturbances may almost invariably be obviated by treating all wounds in the manner indicated in the foregoing. For wounds which involve large blood-vessels, see HEMORRHAGE