Backwoods Surgery & Medicine

by Charles Stuart Moody

Place your row of stitches half an inch apart all down the wound. When all the stitches are in place you may begin to tie. Take the two ends of the first stitch in your hands and lift up on them; this will bring the edges of the wound together. Tie the thread, turning the first knot under twice to prevent its slipping. After all the stitches have been tied take the handle of your scalpel or the forceps and raise the edges of the skin, which will have rolled in, until they meet each other. This is necessary, as where the skin is rolled in it will not heal readily and leaves an opening for the entrance of bacteria.

Sponge off all the free blood and dust well with surgical powder. Place a pad of gauze that has been soaked in the bichloride solution over the wound, cover that with a wad of cotton and the cotton with a piece of oiled silk, bandage over all, and do not molest for at least three days.

After five days you may remove your stitches in this manner: Cut the stitch near the skin on one side, grasp the knot in the bite of the forceps and pull it out. Be careful not to try to pull the knot through the flesh, and do not leave any end on the part you do pull through the flesh, as it may carry infection down into the wound.

It is a fact not generally known to the laity that a solution of common salt and water will take the place of blood when introduced into the system. Surgeons resort to this practice in performing all very bloody operations. Their method of hypodermoclysis could not be carried out in the camp, of course, but a very good substitute for it can be used. The lower bowel is very receptive of this solution, which by the way, is made by dissolving a teaspoonful of clean common salt in a pint of water. The solution, maintained at blood heat, is introduced into the lower bowel with a fountain syringe. Persons who have lost a great deal of blood, so much in fact that their pulse can hardly be felt at the wrist, will receive great benefit from this procedure. Use at least a gallon of the solution and do not permit it to flow too rapidly into the bowel.

Certain cuts may be dressed without stitches. Proceed as before up to the point of putting in the stitches, then roll up two pieces of gauze as long as the cut and about the size of a lead pencil. Lay these on either side of the wound quite close to it. With adhesive tape half an inch wide and four inches long begin two inches on either side of the wound and carry across, bringing the edges of the wound together. Place these strips half an inch apart until the wound is brought into line. Dress as before, except that you will have to omit the moist gauze, dressing with the powder entirely.

I want to add here that should you run out of sterilized gauze at any time you can make it from any soft cloth by boiling it for ten minutes in the bichloride solution and hanging in the air to dry.

The pain attendant upon any surgical manipulation can be prevented by the hypodermic injection of a solution of cocaine. When you get your hypodermic have the instrument man show you how it works. He can show you much better than I can tell it. Insert the needle half an inch from the wound and inject a few drops of the solution into the skin. Proceed thus entirely around the wound and by the time you are through the wound will be perfectly painless. Before replacing the instrument in its case always dry it out and replace the small brass wire that you will find in the needle.

It is somewhat difficult to approach the subject of punctured wounds, which also include those resulting from gun shots and powder explosions. The rule among surgeons is to meddle with these injuries as little as possible, provided they do not penetrate the abdomen. In the case of penetrating wounds caused by falling on a sharp stick or other sharp pointed instrument, it is well to clean out the wound, removing all foreign substance that may be present, searching diligently for pieces of cloth, rust, charcoal, bark, or other foreign matter. These things in certain localities contain the germ of lock-jaw, and many contain it anywhere.

This is particularly true of felt wads from shotgun shells. All diligence should be exercised to clean out a wound resulting from such a cause. Shotgun wads are manufactured from the most filthy kinds of old hair, often reeking with the bacillus of tetanus.

If the wound was caused by a sliver of wood and the sliver still remains in the wound remove it by making an incision with your bistoury. Do not be afraid to cut. A little cut is worse than none; go deep enough to liberate the sliver so that it may be removed with the splinter forceps. Then wash the wound from the bottom with hot water and dress as before, using the bichloride.