Dealing with Puncture Wounds
Dealing with Puncture Wounds
It is somewhat difficult to approach the subject of punctured wounds, which also include those resulting from gun shots and powder explosions. The rule among surgeons is to meddle with these injuries as little as possible, provided they do not penetrate the abdomen. In the case of penetrating wounds caused by falling on a sharp stick or other sharp pointed instrument, it is well to clean out the wound, removing all foreign substance that may be present, searching diligently for pieces of cloth, rust, charcoal, bark, or other foreign matter. These things in certain localities contain the germ of lock-jaw, and many contain it anywhere.
This is particularly true of felt wads from shotgun shells. All diligence should be exercised to clean out a wound resulting from such a cause. Shotgun wads are manufactured from the filthiest kinds of old hair, often reeking with the bacillus of tetanus.
If the wound was caused by a sliver of wood and the sliver still remains in the wound remove it by making an incision with your bistoury. Do not be afraid to cut. A little cut is worse than none; go deep enough to liberate the sliver so that it may be removed with the splinter forceps. Then wash the wound from the bottom with hot water and dress as before, using the bi-chloride.
Experience has proved that the less one attempts to do with gunshot wounds the better. Nature has a tendency to wall off foreign bodies that are in the main sterile and will ordinarily do so with a bullet if given a chance. Keep the patient quiet, prevent infection from entering the wound, and trust to Nature to do the rest.
An incident will illustrate what takes place when Nature is given an opportunity to throw out her plastic wall material around a foreign body. Some years ago a party of Eastern people were camping in the heart of the Bitter Roots. Among the party were two boys of the age when boys are prone to try experiments. They bored a small hole in a spruce tree and drove into it a high power 30-30 cartridge. Then they stood off some fifteen feet and fired at the cartridge with a small rifle. One of them hit it.
The 30-30 shell came back and penetrated the abdomen of the juvenile marksman, burying itself and driving pieces of clothing into the abdominal cavity. The messenger who came for me was thirty-six hours on the trail and I was an equal length of time reaching the camp. The people had had sense enough to keep the patient quiet and I found him resting fairly easy. So deeply had the missile penetrated that it required a considerable incision to remove it.
When I reached the bottom of the wound I found that Nature had thrown about the wounded area a wall of protective lymph and all the pus that had accumulated was in a pocket. I laid the pocket well open, evacuated its contents, and removed the bits of cloth that I found, dressed the wound, and had the satisfaction of seeing the youngster recover.
Moody, Charles Stuart. Backwoods Surgery & Medicine. New York: Outing Pub., 1916. Print.
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