Salt in the Wound? No, But A Little Honey Won’t Hurt - The Evolution of Wound Care Nurisng

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Evolution of Wound Care Nursing

Descriptions of ancient medical procedures can make for entertaining reading, at least for those of us in the healthcare professions. Leeches, bloodletting, amputations using whiskey for anesthesia... Our healing predecessors were certainly creative, to say the least. In the spirit of celebrating just how far nursing care has come since 3600 B.F.N. (before Florence Nightingale) or so, let’s take a common nursing task—wound care—and look at how it has evolved over time.

Of Ants and Antiseptics

Some of the earliest medical records, dated around 1500 B.C. in ancient Egypt, describe the standard treatment for an open wound at that time: apply a piece of fresh meat to the site as soon as possible (the source of said meat was apparently left to the healer’s discretion), and after a few days, put lint in the wound and apply an ointment composed of honey or animal grease. The lint provided a fibrous base that promoted wound site closure, the animal grease provided a barrier to infectious substances, and the honey served as an antiseptic agent. (We now know that both honey and animal grease do indeed inhibit the growth of bacteria). The edges of packed wounds were held together with thorns, figs, linen strips—or, in a pinch, ant pincers. But despite their early medical savvy, the Egyptians weren’t entirely consistent in their approach to infection prevention. Because they thought wounds could serve as an entry point for mischievous spiritual entities, they’d also occasionally pack them with donkey feces in an effort to repel invaders. Perhaps not coincidentally, tree resins were often used to help control wound odor.

It’s All Greek. . .

In the Iliad, (800 B.C.), Homer wrote of the treatment of numerous battle wounds sustained during the Trojan War and described how surgeons pulled out any weapons that had penetrated the skin, washed the wound with warm water and dressed it. They also used a powdered root to stop bleeding and provide pain relief. Hippocrates (460–370 B.C.) advocated the use of wine or vinegar for washing wounds, while boiled wool was considered to be an appropriate bandage. And Galen (131–201 A.D.), physician to the Greek Emperor Marcus Aurelius, was the first to stress the importance of maintaining wound-site moisture to ensure successful closure of the wound. Unfortunately, the Greeks’ progress in the area of wound care was temporarily lost in the Dark Ages, when bloodletting became a popular healing technique and wounds were encouraged to fester until a “healing pus” could form.

Clean Is A Good Thing

Fast forward to the 19th century, and we can credit Hungarian obstetrician Ignaz Semmelweis with the happy discovery that frequent hand washing and general cleanliness during medical procedures reduced both mortality and infection rates among his patients. In the 1860s, English surgeon Joseph Lister began pre-treating his surgical gauze with carbolic acid with the same results, which led Robert Wood Johnson, co-founder of Johnson & Johnson, to produce gauze and wound dressings pre-treated with iodine. Other significant developments in this era, such as heat sterilization of surgical instruments, excision of open wounds and mass production of sterile dressings also began to reduce infection rates.

By the early 20th century, antiseptics were being applied directly to wounds. During WWI, chemist Henry Dakin invented Dakin's solution, comprised of sodium hypochlorite and boric acid, to wash out the traumatic wounds of British soldiers fighting in France. And following the widespread introduction of penicillin, the first surgical closure of a pressure ulcer was made possible in 1945. During WWII, new types of wound dressings, such as purified bleached gauze and fine mesh gauze, became common, followed in the 1950s by synthetic materials such as nylon, polyethylene and polypropylene that could actually accelerate the natural wound healing process. In the 1960s, research by George Winter and Howard Maibach led to the adoption of moist wound dressing as the recommended best wound dressing practice, a development that marks the dawn of modern wound care treatment.

Today, grafting techniques and developments in the field of biotechnology make it possible to treat wounds with coverings of actual human skin generated through cloning procedures—a far cry from the days of ant pincers and animal fat! Nurses have more tools and techniques at their disposal than ever before when treating wounds, which allows them to focus more on overall pain management and the comfort level of the patient.

So the next time you find yourself caring for a patient’s wound, consider all the wise (and some not-so-wise) caretakers who have come before you, and perhaps reach for some honey along with your bandage. But the vinegar? Maybe leave that for the salad dressing.

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