第六十六章 伤口
1.Skin is the best dressing.
—— Joseph Lister, 1827——1912
【译文】皮肤是最好的敷料。
2.The wound is a window into the body.
【译文】伤口是进入身体的门户。
3.The fate of the surgical wound is sealed during the operation; almost nothing can be done after the operation to modify the wound's outcome.
—— Moshe Schein
【译文】手术伤口的命运在手术过程中已落定，术后几乎没有什么努力可改变伤口的结局。
【点评】因此，应谨慎处理手术的每一步。
4.The likelihood of wound infections has been determined by the time the last stitch is inserted in the wound.
—— Mark M.Ravitch, 1910——1989
【译文】缝合伤口的最后一针时就决定了伤口是否会发生感染。
5.The great ignominy to the plastic surgeon is his inability to remove a scar without leaving another.
—— Harold Gillies, 1882——1960, & Ralph D.Millard, Jr.
【译文】对整形外科医生来说，最大的耻辱是他不能在不留下疤痕的情况下切除瘢痕。
【点评】如果措施做到位，有可能让大疤变小疤。
6.Wounds cannot be cured without searching.
—— Francis Bacon, 1561——1626
【译文】不查明伤口的缘由如何能治愈。
【点评】作为哲学家的弗朗西斯·培根原意说的是“心灵的伤口”，引申到机体的伤口也是一样的道理。
7.No wound, let it be ever so small, should be made larger, excepting when preparatory to something else ...it should not be opened because it is a wound but because there is something necessary to be done, which cannot be executed unless the wound is enlarged.
—— John Hunter, 1728——1793
【译文】 任何伤口，任其多小，也不应该扩大它，当然准备做其他什么事例外……不要因为它是一个伤口就去打开它，除非不扩大它无法做一些其他必须做的事。
8.Clinical experience has demonstrated the great value of absorbent material.Discharges drain through them so rapidly that wounds are kept clean and the surrounding parts dry.
—— Jospeh S.Gamgee, 1828——1886
【译文】临床经验证明了吸附性材料的巨大价值。渗液可通过它们迅速排出，从而让伤口保持清洁，周围组织保持干燥。
9.The irritation of wound by antiseptic irrigation and washing may therefore now be avoided, and nature left quite undisturbed to carry out her best methods of repair.
—— Joseph Lister, 1827——1912
【译文】因此，应避免用消毒水冲洗给伤口带来的刺激，任由大自然不受干扰地进行其自身的最佳修复方式。
10.The severity of wound infections is merely the result of the extensive destruction of tissues by the projectile ...if it were possible for the surgeon to remove this dead tissue I am sure infections would sink into insignificance.
—— Alexander Fleming, 1881——1955
【译文】伤口感染的严重程度只不过是炮弹广泛破坏组织的结果……如果外科医生能够去除这些坏死的组织，我相信感染将变得无足轻重。
11.Dressings on undrained wounds serve only to hide the wound, interfere with examination, and to invite adhesive tape dermatitis.
—— Mark M.Ravitch, 1910——1989
【译文】对未经引流的伤口进行包扎，只会掩盖伤口，干扰检查，并引起胶带性皮炎。
【点评】更重要的是加重伤口的感染。
12.A surgeon should not wear a long tie that could dangle embarrassingly and dangerously down into a wound or incision while he leans over the patient.
—— Francis D.Moore, 1913——2001
【译文】外科医生不应该系长领带，否则当他俯身靠近患者时，会尴尬而危险地晃到伤口或切口上。
13.No wounds should be moistened with anything except wine unless the wound is in a joint.Because dryness is more nearly a condition of health, and moisture more nearly allied to disease.
—— Hippocrates, 460——377 BC
【译文】除非伤口在关节处，否则不能用酒以外的任何东西沾湿，因为干燥更接近健康状态，而潮湿更接近疾病状态。(https://www.daowen.com)
14. Indeed, above all else, a wound must be made clean.
—— Theodoric, 1205——1296
【译文】的确，最重要的是，伤口必须清理干净。
15. Soap and water and common sense are the best disinfectants.
—— William Osler, 1849——1919
【译文】肥皂、水和常识是最好的消毒剂。
16. When in doubt as to which disinfectant to use, try soap and water.
—— Martin H.Fischer, 1879——1962
【译文】如果对使用哪种消毒剂有疑问，可尝试肥皂和水。
17.If thou examinest a man having a gaping wound piercing through to his gullet; if he drinks water he chokes (and) it come out of the mouth of his wound; it is greatly inflamed, so that he develops fever from it; thou shouldst draw together that wound with stitching.Thou shouldst bind it with fresh meat the first day.Thou shouldst treat it afterward with grease, honey (and) lint every day, until he recovers.
—— Edwin Smith Papyru, written in Egypt 3000 years ago
【译文】如果你看到一个咽喉被穿透并豁开一个大口子的人，喝水时呛咳，水从伤口溢出来，炎症很重并导致发热，你就应该把伤口缝起来，趁第一天创面新鲜将其固定住，以后每天用浸有油膏、蜂蜜的纱布敷在伤口上，直到痊愈。
【点评】3000年前埃及人就有如此大智慧。
18. One should not put fingers into a wound, but when other methods fail do not hesitate to apply pressure directly on the bleeding point.It is much better to have a live patient with a dirty wound than a dead patient with a clean wound.
—— American Red Cross First Aid Text-Book, 1933
【译文】一般不要将手指放入伤口，但当其他方法失败时，就不要犹豫，用手指直接压住出血点。一个伤口被污染的活人远好过一个伤口清洁的死人。
19.The wound surgeon: he should always give industrious attention to the parts of the body and their action, and to the blood vessels, so that he may cut,cauterize with corrosives, or burn with iron or gold instruments, without doing injury to the limb.
—— Hans von Gersdorff, 1480——1540
【译文】外伤医生：应该密切关注身体各个部位及其活动情况，包括血管，以决定是切除、用腐蚀剂还是用金属器械烧灼，而不会对肢体造成伤害。
【注】那个年代“the wound surgeon”还不能称为“外科医生”。实际就是剃头匠兼职处理一些体表外伤而已的人。
20. Keep them as neat and clean as possible, and disturb them as little as you can; so far as may be practicable, exclude the air; favor healing under the scab;and ...feed him as you would a woman recovering from her confinement.
—— Felix Wurtz, 1518——1574
【译文】尽量保持洁净，少滋扰，尽量排出气体，这样有利于痂下愈合；以及……像对待一个从月子里恢复过来的女人那样养着。
21. I dressed him and God healed him.
—— Ambroise Paré, 1510——1590
【译文】我包扎伤口，上帝负责愈合。
22.The art of healing depends on local conditions / The physician is only nature's assistant.
—— Galen
【译文】愈合的玄机取决于局部的情况/医生只是大自然的助手。
23. And yet, how many infallible healing balsams, and wonderful nostrums have been and still are imposed upon the world, not only by Quacks and Empirics,but too many, whose education and knowledge of the animal oeconomy should render them incapable of low artifact, or ignorance of nature's admirable efforts for her own relief.
—— John Jones, 1729——1791
【译文】然而，究竟有多少可靠的愈创香膏和奇药妙方已经并继续被强加于这个世界，不仅有江湖郎中和祖传名医，而且还有太多的人。或许他们所受教育和其对动物营生能力的了解让他们不能抵御这些低劣的人工制品，或者对大自然那套令人钦佩的自我保护的本能一无所知。
24. I describe to my students what an injured animal does: it lies under a shady bush (rest, splint) by a water source (fluids, nutrition), licks the wound frequently(dressing changes) until it is clean and healing (time and patience)——and hope it makes them think past the gorgeous dressing promoted by manufacturers' reps.
—— Barry Alexander
【译文】我给我的学生们描述了一只受伤动物所做的事情：它躺在靠近水源（液体、营养）的阴凉灌木丛（休息、夹板）下，经常舔伤口（换药），直到伤口清洁和愈合（时间和耐心）——希望这能让他们抛弃那些由制造商代表所推销的各种华丽敷料。
【点评】这就是前一句所提到的自然界“那一套令人钦佩的自我修复本能”。
25. One of them ...with a compound fracture of the leg, died the next day, the indication of the lethal nature of wounds received on the richly manures grounds of northern France and Flanders.
—— Geoffrey Keynes, 1887——1982
【译文】其中一个……第二天死于腿部复合骨折，这表明在法国北部和佛兰德斯肥沃的土地上所受伤的伤口具有致命性。
26.We soon learned ...of the difference between wounds sustained on the clean South African veldt and those contaminated by European mud.Anaerobic bacteria lurking in the soil were responsible for the gas gangrene, which proved to be one of the chief causes of death among those men who reached a base hospital alive.
—— Geoffrey Keynes, 1887——1982
【译文】我们很快就知道……在干净的南非草原上留下的伤口和被欧洲泥巴污染的伤口之间的区别。潜伏在土壤中的厌氧菌是气性坏疽的罪魁祸首，这被证明是那些活着到达基地医院的人的主要死亡原因之一。