Surgical Experiences in South Africa, 1899-1900: Being Mainly a Clinical Study of the Nature and Effects of Injuries Produced by Bullets of Small CalibreMakins, George Henry
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Surgical Experiences in South Africa, 1899-1900: Being Mainly a Clinical Study of the Nature and Effects of Injuries Produced by Bullets of Small Calibre
Makins, George Henry
Gunshot wounds; South African War, 1899-1902; Surgery, Military
The wound having been once cleansed, or rather the surroundings of the
wound, the drier the surface was kept the better; hence a too heavy or
impervious dressing was not satisfactory; in point of fact, I think some
of the slighter wounds in which all the dressings slipped off, and in
which there was less consequent chance of the dressing being moistened
with the sweat of the patient, did as well as any.
I do not think the bicyanide gauze, absorbent wool, and common open-wove
bandages, together with a good supply of nail brushes, soap, and
carbolic acid for the primary disinfection of the skin and the external
wound, are to be greatly bettered at the present day as materials for
the first permanent dressing of cases in the field. The wound itself
should be carefully shielded during the preliminary cleansing of the
skin by a firmly applied antiseptic pad, and then the dressing applied
as above described. The one desirable improvement is some mode of
ensuring the dressing being kept in good position, and for this some
form of adhesive covering for the gauze and wool should be devised. When
the atmosphere is such as to allow of rapid drying, thin moistened
book-muslin bandages would be preferable to the plain open-wove ones.
The one period of danger is that of transport, and when that is over,
the dressing in Stationary or Base hospitals should give no trouble.
As a rule the wounds themselves need no interference, but in some
instances either the exit or entrance wounds may be in undesirable
positions for purposes of asepsis, when a large opening may seem safer
closed and actually sealed. I saw this method tried in a few cases, but
without much success. It is one which might be of much use in Base
hospitals if the patients were brought directly into them, but in the
Field hospitals, in face of the rush with which the first dressings have
to be done, I think it is seldom applicable, and consider the
interference with the wound as rather likely to increase the danger of
infection than to decrease it.
Dressings should not be too frequent; two should suffice for simple
wounds with type forms of entry and exit; there is little discharge and
usually no bleeding: hence the more the dry scab form of healing can be
simulated the better. When a dressing needs changing from fouling of its
outer parts, it is preferable to cut round the adherent part of the deep
layers and apply some fresh gauze over the central scab rather than to
remove it. One point should be kept in mind: the first dressing in the
Field hospital seals the fate of the wound as to the chances of primary
union, and hence too much care is impossible with it.
Public-domain text, read in full here on John Shaqi.
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