Symptoms of wounds.-The injury itself, pain, bleeding. After some wounds the patient may go into shock (p. 220.) GENERAL PRINCIPLES OF THE TREATMENT OF WOUNDS. From what has been said concerning the action of bacteria on wounds, it is evident that great care must be exercised in handling or dressing these injuries to prevent the introduction of living germs. INFECTED WOUNDS. A wound that contains bacteria is said to be an infected wound. Attempts to destroy the bacteria in a wound is known as disinfecting it. Many wounds are infected at the time they are received, because the knife or other instrument has bacteria on it and these were left in the flesh (fig. 141). There are other sources of infecting open FIG. 141.-Bacteria being intro a on a wounds such as the hands or instruments used in treating them and the dressings which are applied. As our hands and the ordinary materials like muslin or gauze which might be used for dressings always contain numerous germs, before handling or treating a wound it is necessary to take certain precautions to kill the bacteria on everything which is going to be used about the injury, and also to prepare or to use a specially prepared dressing. Even after these preparations have been made, great care must be exercised to see that the hands or dressing do not come in contact with some object which has not been so treated and new germs be thus picked up. Sterilization.-The best way to kill bacteria is with heat. All dressings, instruments, and other substances which are used in wound dressing are therefore first heated, generally by boiling water or steam, and are then said to be sterile. The process of killing bacteria is known as sterilization. It is impracticable, of course, to steam the hands of the doctor or dresser, so special means must be used to free these of living germs before dressing or handling a wound, if it is possible to do so. duced into Preparation or sterilization of the hands.-The hands should be thoroughly scrubbed for five minutes with a nail brush, hot water and soap. Then the fingernails should be cut short and the spaces under the nails thoroughly cleaned out, after which the hands and nails are again scrubbed for five minutes. After the second scrubbing the hands should be rinsed in clean water and soaked for several minutes in a solution of one to two thousand of bichloride of mercury, a 3 per cent solution of compound cresol, or a mixture of 2 parts of grain alcohol with 1 of water. These chemicals are used in order to kill the few germs which may have escaped the scrubbing process, but the thorough rubbing and soaking is of more importance than the use of the special solutions. After preparing the hands in this manner they must not be wiped on an ordinary towel, even though it is clean, because the towel will probably contain bacteria and undo to a certain extent the preceding processes. After the hands have been sterilized in the above manner great care must be taken not to touch any object which has not been previously boiled or steamed. An assistant should remove any bandages and the top dressings, and be at hand in order to give any assistance which will be required so that it will not be necessary for the operator to touch anything but the boiled instruments, sterile dressings, or the wound itself. On account of the nails and the various cracks and crevices around the hands it is very difficult to sterilize them completely by any process. Hence, in recent years surgeons have been wearing rubber gloves to a great extent when operating or dressing wounds. Such gloves can be boiled and rendered perfectly free from germs. It is always advisable, however, before putting on the gloves, to wash the hands as thoroughly as possibly, because during the operation the glove may be torn and bacteria introduced from the hands into the wound through the hole in the glove. Metallic objects, like instruments, basins, or pans, are sterilized by boiling in water for 10 or 20 minutes. The hot water should be poured off without touching the instruments and they should be allowed to remain in the pan and the pan carried to the bedside. If it becomes necessary to lay down the instrument, it should be placed in the pan again, and not on a table or similar place, as in this way it can be kept sterile. In doing home dressings, it is an excellent plan to place a little water in several clean agate basins or pans, put on the covers, and place them on the stove and allow to boil for 10 minutes. The hot water can be thrown out and the inside of the pans will be sterile and afford a safe place in which to deposit sterile dressings or instruments while the wound is receiving attention. Sterile dressings. Whenever possible, all dressings which are to be used on wounds should have been previously treated with heat so as to kill the bacteria. Materials prepared in this way are called sterile dressings. This means that there are no living bacteria on them. Usually sterilized dressings are carefully wrapped up in paraffined paper, sealed in jars, or otherwise protected so that they will remain free from germs as long as the covering is intact. After such a package has been opened and the contents handled, it is no longer sterile because a few bacteria will certainly be deposited on the dressing by such handling. Sterile gauze for dressings, properly sealed in various size packages can be obtained at most drug stores. One firm at the present time is putting up such gauze in pieces half a yard square, and each piece separately sealed in a paraffined envelope. This method of preparing gauze is a very excellent one for home use, as there is no danger in infecting the rest of the supply when taking out a piece for a wound dressing. Prepared gauze impregnated with various medicinal substances such as bichloride of mercury, carbolic acid, etc., is often used on wounds. This is known as antiseptic gauze. Unless the hands have been carefully prepared previously, great care must be exercised in opening and handling sterile dressings. Such dressings should be taken out of the jar or package by touching them on one corner only (fig. 142). They should not be allowed to touch any other object before they are placed on the wound, and the dressing should be so applied that the part which has come in contact with the fingers does not come in direct opposition with the broken skin. When time is available and no regular sterilized dressings are at hand, ordinary muslin or similar material can be sterilized in the following manner: The muslin or gauze should be cut of sufficient size and properly folded to the correct size and shape so that it is all ready to be laid on the wound. Then it should be placed in a clean saucepan and a little water poured over it. The saucepan should be tightly covered and the dressing boiled for 20 minutes. The excess water should be poured off by inverting the saucepan and lifting the lid a little. Then the pan can be turned right side up again, the lid removed, and the dressing dried out in the oven, or with care on the top of the stove. It will do no harm if it is slightly scorched, but it should be dry and cool before being applied. Dressings can also be sterilized by baking them thoroughly in a hot oven. They should be placed in a pan so that the dressings can be removed from the oven without touching them directly. When regularly sterilized dressings are not available one should use material which is as free from germs as possible, such as freshly laundered handkerchiefs, old linen, towels, etc., which have not been used. The process of laundering and the heating and ironing will kill a great many of the microorganisms which are found on such materials, but of course they are constantly collecting new bacteria on account of the handling which they must undergo. However, in an emergency such freshly laundered dressings are very much better than the soiled rags or cloths which are very often placed on wounds. Germicides and antiseptics,-Chemicals which will kill bacteria |