No part of medicine has been more mistaken than the treatment or cure of wounds. Mankind in general believe that certain herbs, ointments, and plasters are possessed of wonderful healing powers, and imagine that no wound can be cured without the application of them. It is however a fact, that no external application whatever contributes towards the cure of a wound, any other way than by keeping the parts soft, clean, and defending them from the external air, which may be as effectually done by dry lint, as by the most pompous applications, while it is exempt from many of the bad consequences attending them.
The same observation holds with respect to internal applications. These only promote the cure of wounds as far as they tend to prevent a fever, or to remove any cause that might obstruct or impede the operations of Nature. It is Nature alone that cures wounds. All that Art can do is to remove obstacles, and to put the parts in such a condition as is the most favourable to Nature’s efforts.
With this simple view we shall consider the treatment of wounds, and endeavour to point out such steps as ought to be taken to facilitate their cure.
The first thing to be done when a person has received a wound, is to examine whether any foreign body be lodged in it, as wood, stone, iron, lead, glass, dirt, bits of cloth, or the like. These, if possible, ought to be extracted, and the wound cleaned, before any dressings be applied. When that cannot be effected with safety, on account of the patient’s weakness, or loss of blood, they must be suffered to remain in the wound, and afterwards extracted when he is more able to bear it.
When a wound penetrates into any of the cavities of the body, as the breast, the bowels, &c. or where any considerable blood-vessel is cut, a skilful surgeon ought immediately to be called, otherwise the patient may lose his life. But sometimes the discharge of blood is so great, that if it be not stopt, the patient may die even before a surgeon, though at no great distance, can arrive. In this case, something must be done by those who are present. If the wound be in any of the limbs, the bleeding may generally be stopt by applying a tight ligature or bandage round the member a little above the wound. The best method of doing this is to put a strong broad garter round the part, but so slack as easily to admit a small piece of stick to be put under it, which must be twisted, in the same manner as a countryman does a cart-rope to secure his loading, till the bleeding stops. Whenever this is the case, he must take care to twist it no longer, as straining it too much might occasion an inflammation of the parts, and endanger a gangrene.
In parts where this bandage cannot be applied, various other methods may be tried to stop the bleeding, as the application of styptics, astringents, &c. Cloths dipped in a solution of blue vitriol in water, or the styptic water of the Dispensatories, may be applied to the wound. When these cannot be obtained, strong spirits of wine may be used. Some recommend the agaric[[194]] of the oak as preferable to any of the other styptics; and indeed it deserves considerable encomiums. It is easily obtained, and ought to be kept in every family, in case of accidents. A piece of it must be laid upon the wound, and covered with a good deal of lint, above which a bandage may be applied so tight as to keep it firmly on.
Though spirits, tinctures, and hot balsams may be used, in order to stop the bleeding when it is excessive, they are improper at other times. They do not promote but retard the cure, and often change a simple wound into an ulcer. People imagine, because hot balsams congeal the blood, and seem, as it were, to solder up the wound, that they therefore heal it; but this is only a deception. They may indeed stop the flowing blood, by searing the mouths of the vessels; but, by rendering the parts callous, they obstruct the cure.
In slight wounds, which do not penetrate much deeper than the skin, the best application is a bit of the common black sticking-plaster. This keeps the sides of the wound together, and prevents the air from hurting it, which is all that is necessary. When a wound penetrates deep, it is not safe to keep its lips quite close: this keeps in the matter, and is apt to make the wound fester. In this case the best way is to fill the wound with soft lint, commonly called caddis. It however must not be stuffed in too hard, otherwise it will do hurt. The lint may be covered with a cloth dipped in oil, or spread with the common wax plaster[[195]]; and the whole must be kept on by a proper bandage.
We shall not spend time in describing the different bandages that may be proper for wounds in different parts of the body; common sense will generally suggest the most commodious method of applying a bandage; besides, descriptions of this kind are not easily understood or remembered.
The first dressing ought to continue on for at least two days; after which it may be removed, and fresh lint applied as before. If any part of the first dressing sticks so close as not to be removed with ease or safety to the patient, it may be allowed to continue, and fresh lint dipped in sweet oil laid over it. This will soften it, so as to make it come off easily at next dressing. Afterwards the wound may be dressed twice a-day in the same manner till it be quite healed. Those who are fond of salves or ointments, may, after the wound is become very superficial, dress it with the yellow basilicum[[196]]; and if fungous, or what is called proud flesh, should rise in the wound, it may be checked, by mixing with the ointment a little burnt alum or red precipitate of mercury.