Up to the present, these articles have dealt mainly with what is called, in hospital, medical nursing. The surgical side of sick nursing, however, ought to be studied by everyone who wishes to have a practical grasp of the subject. Under the heading of "surgical nursing"must' be included all accidents as well as those cases which require surgical dressings to be applied from day to day.
Accidents, big or small, must come into the lives of the great majority of people, and this makes it necessary for anyone to know, not only the first aid treatment of these, which has already been considered in Every Woman's Encyclopaedia (Vols. 1 and 2), but the care or management of an accident case in the home.
There are women who do not even know how to dress a cut finger, and many cases of poisoned hand occur as a result of neglect and carelessness in this respect, which is proof that better teaching with regard to simple surgery is. needed. Although a doctor must always be called in when an accident occurs, there is no reason why the amateur nurse should not feel herself perfectly competent to dress cuts, bruises, and burns, to manage a fracture case, apart from the setting of the bone, which is, of course, a doctor's work.
Preparing for the Patient
Supposing an accident has occurred, and the patient is being brought home, what preparations should be made for his reception ?
The bedroom, in the first place, must be got in readiness. When a doctor has to apply surgical attention to the case, a single narrow bed is a necessity. This should be supplied with a hard mattress, a waterproof sheet, aired sheets and blankets, and a clean sheet on the top will answer the purpose of a bed-spread.
In the case of fractures or dislocations a wooden slab or board will be required under the mattress to provide firmness and flatness. The bed, of course, must stand out from the wall, in order that the doctor and nurse can pass round it comfortably from either side. A table covered with a clean cloth or a towel should be placed at the foot of the bed, and the following materials collected as quickly as possible.
First you must have a clean tray containing lint or pieces of soft linen cut into strips, bandages of cotton or flannel torn in long strips, cotton-wool, boracic powder, and zinc ointment. Safety-pins, scissors, needles, and thread should also be collected and placed beside the dressings. Probably it will be necessary to send out to the chemist for lint and waterproof tissue. On another table or washstand two clean basins must be prepared, and plenty of hot and cold water held in readiness. The doctor, of course, will want several clean towels and soap. When sending out for other things, it is just as well to buy a new nail-brush, in case the doctor has not one in his bag.
The patient should be carried into the room, and, if any soiled clothing has to be removed, it is a good plan to lay him first upon another bed or couch, which can be covered with a sheet, in order to keep the bed in which he is to be nursed clean for his reception.
The amateur nurse should make a careful inspection of the patient, and guard the injured limb from all movement. If the doctor can be obtained quickly, no interference should be made with the patient, unless to stop haemorrhage, as was described under the first aid articles. So far as the nurse is concerned first aid has probably been provided before she sees the case at all, and bleeding from scalp or body wound would by her be treated by the application of a clean pad of lint kept in place by a bandage. When the doctor arrives, she has to act as his assistant and hand him the dressings, hold the injured part, and help him in innumerable little ways.
There are, briefly, four classes of wounds :
Incised or clean wounds, such as would be inflicted by a sharp instrument.
Lacerated wounds, where there is a good deal of tearing.
Contused, where the parts are injured round about the wound, as when a blow is inflicted by a heavy blunt instrument.
Punctured wounds - that is, when a wound is made by a sharp-pointed instrument.
The great danger with accidental wounds is from dirt or sepsis. Unless the wound is carefully cleansed with antiseptics it is liable to suppurate, and it is here that the nurse has such an important part to play. If wounds are kept clean, the tissues heal in a miraculous fashion. Material called " lymph " oozes out from the blood-vessels, covers the surface of the wound, glues the tissues together, and thus unison gradually takes place. To help this natural process of healing, the wound must be kept clean, the parts at rest, and the patient in good general healthy condition. A wound should never be examined with dirty fingers, or cleansed with any other than perfectly clean water, or covered with dressings which are not clean and aseptic. Dirt, in the surgical sense, means that microbes have been allowed to enter the wound and multiply there. These may reach the wound by infective particles of dust being allowed to enter it, conveyed perhaps by the hands of the person dressing the wound or the materials used for dressing it.
Thirty years ago, when the causes of infection were not known, nearly all the wounds became septic, or "suppurated " in the process of healing. Even after a patient had been operated on, he would be months getting well, instead of, as now, up and about in a few weeks. We now know that when a wound suppurates some person is to blame in having allowed microbes to enter it and infect it. These microbes, or germs, are to be found everywhere, indoors and out of doors, in the fine, invisible dust which is in the atmosphere. It is these same germs which cause meat to become tainted, milk to sour, bread or other food to become mouldy if allowed to lie about, especially in damp, ill-ventilated places.