TREATMENT OF WOUNDS AND INJURIES.
By the late William Henry Crosse, M.D.
In treating wounds, whether large or small, the great essential is absolute cleanliness, not simple cleanliness in the ordinary acceptance of the word, but absolute surgical cleanliness.
In the first place, it is as well to lay down the axiom that all inflammation and other complications of wounds, as suppuration and blood-poisoning, are due to germs, and germs alone. All cleansing operations and antiseptic processes are instituted with the sole idea of preventing the entrance of germs into the wound, either from the hands of the operator, the dressings, instruments, or the skin of the patient.
Antiseptics are chemical substances which have the power of killing germs outright, or so checking their growth that the cells in the blood can easily cope with them. The antiseptics that are mentioned in these notes are carbolic acid, chinosol, permanganate of potash, and boric acid.
Given the antiseptic properties of the substance, it seems a simple thing, by its application, to prevent germs either entering a wound or multiplying there, but in actual practice the germ-free cleanliness of a wound is a difficult thing to procure. The germs are everywhere—on the instruments which cause the wounds, on the skin of the patient, in the sweat glands of the skin, at the roots of the hairs, and on the hands of the operator, especially under the nails. Again, a great obstacle to the free action of antiseptics is grease or oil of all kinds. A fine coating of grease enveloping a germ offers great resistance to the action of antiseptics, and the object of the process of cleansing a wound described below is, first, to remove all the grease, and then to apply the antiseptic to destroy the germs. With care, a clean-cut wound should heal kindly, without the formation of matter.
To clean and dress a Wound.
First cover the wound itself with a small piece of cotton-wool or lint, wrung out in an antiseptic solution; then thoroughly scrub the surrounding skin with warm water and soap (soft soap for preference), using a nail brush which has been previously boiled.