If the attendant has the requisite confidence, there is no reason why he should not attempt stitching a wound, providing the patient is willing, and a surgeon cannot be obtained within twenty-four hours. In this case a rather stout, common sewing needle or needles are threaded with black or white thread, preferably of silk, and, together with a pair of scissors and a clean towel, are boiled in the same utensil with the cotton and the nail brush. After the operator has scrubbed his hands and cleansed the wound, he places the boiled towel about the wound so that the thread will fall on it during his manipulations and not on the skin. The needle should be thrust into and through the skin, but no lower than this, and should enter and leave the skin about a quarter of an inch from either edge of the wound. The stitches are placed about one-half inch apart, and are drawn together and tied tightly enough to join the two edges of the wound. The ends of the thread should be cut about one-half inch from the knot, being careful while using the needle and scissors not to lay them down on anything except the boiled towel. The wound is then covered with cotton, which has been boiled as described above, bandaged and left undisturbed for a week, if causing no pain. At the end of this time the stitches are taken out after the attendant has washed his hands carefully, and boiled his scissors as before.
Court plaster or plaster of any kind is a bad covering or dressing for wounds, as it may be itself contaminated with germs. It effectually keeps in any with which the wound is already infected, and prevents proper drainage.
It is impossible in a work of this kind to describe the details of the after treatment of wounds, as this can only be properly undertaken by a surgeon, owing to the varying conditions which may arise. In general it may be stated that the same cleanliness and care should be followed during the whole course of healing as has been outlined for the first attempt at treatment.
If the wound is small, and there is no discharge from it, it may be painted with collodion or covered with boric-acid ointment (sixty grains of boric acid to the ounce of vaseline) after the first day. If large, it should be covered with cotton gauze or cloth which have been boiled or specially prepared for surgical purposes. If pus ("matter") forms, the wound must be cleansed daily of discharge (more than once if it is copious) with boiled water, or best with hydrogen dioxide solution followed by a washing with a solution of carbolic acid (one teaspoonful to the pint of hot water), or with a solution of mercury bichloride, dissolving one of the larger bichloride tablets, sold for surgical uses, in a quart of water.
It is a surgical maxim never to be neglected that wounds should not be allowed to close at the top before healing is completed at the bottom. As to close at the surface is the usual tendency in wounds that heal slowly and discharge pus, it is necessary at times to enlarge the external opening by cutting or stretching with the blades of a pair of scissors, or, and this is much more rational and comfortable for the patient, by daily packing the outlet of the wound with gauze to keep it open.
BLEEDING FROM SCALP.
First Aid Rule 1.—Cut hair off about wound, and clean thoroughly with carbolic-acid solution (one teaspoonful to pint of hot water).
Rule 2.—Put pad of gauze or muslin directly over wet wound, and make pressure firmly with bandage.
In case of wounds of the scalp, or other hairy parts, the hair should be cut, or better shaved, over an area very much larger than the wounded surface, after which the cleansing should be done. To stop bleeding of the scalp, water is applied as hot as can be borne, and then a wad of boiled cotton should be placed in the wound and bandaged down tightly into it for a time. Closing the wound with stitches will stop the bleeding much more effectively, however, and is not very painful if done immediately after the accident. The stitches should be tied loosely, and not introduced nearer to each other than half an inch, to allow drainage of discharge from the wound.
General Remarks.—All wounds should be kept at rest after they are dressed. This is accomplished in the case of the lower limbs by keeping the patient in bed with the leg raised on a pillow.