There are innumerable germs, each one producing special effects. For example, some of these germs in the air might produce erysipelas. Others would cause simple suppuration, these latter germs being the commonest of all. The art of modern surgery is to keep all these germs out of the wound, and if they were kept out no antiseptics would be required. Formerly, the idea was that, if plenty of antiseptics were used they would kill any germs; but Lord Lister founded the school of " aseptic surgery," the theory of which is that if we prevent germs getting near a wound by rigid cleanliness, the use of antiseptics is of minor importance.
There is only one thing which is essential in the treatment of wounds, and that is cleanliness. The nurse's hands must be thoroughly and carefully washed and scrubbed with soap and water and a clean nail-brush, and then soaked in a disinfectant solution, before touching the patient. She should not touch anything, after drying her hands, unless she afterwards washes her hands again. The dressings should be kept in a glass-covered jar. Any water that has to be used should be boiled, and the patient's skin round about washed as well as the wound itself. In home treatment these precautions can quite well be carried out, and they are worth the trouble they entail. Clean towels should be put beside the patient, covering the parts round about the wound. For example, if a wound on a scalp or forehead is to be dressed, a clean towel should cover the rest of the head before the nurse begins to change the dressings.
Dressing a Wound
The wound should be washed in warm water, or warm boracic solution in the strength of one in twenty, and clean tow or cotton-wool should be used - never a sponge or face-flannel. A waterproof sheet should, of course, be laid under the part to be dressed, in order to keep the bed from becoming damp with the water. Wash round the wound with a quick touch, each piece of tow that you use being put in a special receptacle and afterwards burnt. After drying carefully the part with clean lint, the new dressings should be applied, and these should have been already prepared and laid at hand. The doctor will have told the nurse what special dressings he wishes used, and whether they are to be wet dressings or dry dressings.
A useful dry dressing for home use consists of boracic lint, which can be bought ready prepared from the chemist. When it is used the part should first be dusted with a little boracic powder, the lint laid on with perhaps a pad of cotton-wool on top, the whole being kept in place by a gauze bandage.
A wet dressing is used very often when a wound is not clean, and where there is any suspicion that dirt has been introduced when the accident happened. The simplest wet dressing for domestic use consists of a piece of boracic lint wrung out of clean water which has been sterilised by boiling. This must then be covered with a piece of waterproof tissue, which should overlap the wet lint by half an inch all round. A pad of cotton-wool may cover this, and the whole dressing should be kept together by a gauze bandage.
The doctor will tell the nurse how often the wound should be dressed, but unnecessary meddling is always a bad thing; if a wound is doing well it is better to leave it alone. If there is pain, or any discharge coming through the dressings, or if the dressings have shifted, they will require to be renewed. In hospital, if an operation case goes on well without rise of temperature, the wound is often not dressed for several days at a time. There are many different dressings, "such as iodoform gauze, etc., which can be used, but the best plan is for the amateur nurse to get directions from the doctor as to what particular material he prefers.
A Few Rules to be Observed in Dressing a Wound
1. Have everything ready before commencing to change a dressing.
2. The wound should be dressed quickly, but thoroughly and neatly.
3. Wash the wound itself first, if you think that dirt has got in, with some weak antiseptic lotion, such as boracic, then cover it with a piece of clean, wet boracic lint and wash the parts round thoroughly.
4. Do not touch the wound with a soiled swab. A " swab" is a piece of lint or tow used for washing.
5. If a scalp wound is to be dressed the hair should be cut very close for an inch and a half all round.
6. Do not expose the patient more than necessary while dressing the wound, and report to the doctor any signs of suppuration, such as pain or discharge of pus.
Every woman ought to know how to apply a roller bandage efficiently and correctly. The same general rules can be followed whether bandaging burns, wounds, or other accidents. Bandages are made of different substances, such as gauze, linen, calico, or flannel. They must be firmly rolled in the first instance, and they are generally a few yards in length. In applying the bandage the following rules should be observed :
Stand opposite the patient.
Place the outer surface of the roller next the skin in order that it may unwind easily.
Let the first two rolls fix the bandage, round the ankle, for example, as shown in the photograph.
Never unroll more than two or three inches of the bandage at a time.
Bandage from below upwards.
Bandage from within outwards over the front of a limb.
Let each turn of the bandage overlap two-thirds of the previous one.
Apply the bandage firmly if it is to be of any use, but not tightly enough to impede the circulation.
Never use more bandage than is necessary for the purpose. .
The application of the roller bandage according to these directions should be practised round, for instance, the thinner part of the arm. The bandage will be found to lie perfectly straight and even till the thick part of the arm is reached, and this is treated by forming "reverses," which will be described in the next lesson on bandaging.