War Notes 241 



this way he or his assistants treated hundrecls of wounds. In cases 

 of tortuous wounds, the technic was a little more complex. The 

 wound, made larger if necessary, was held open by traction forceps. 

 Then some tepid sol. was poured in until all of the recesses were 

 washed out. The wound, having been well cleaned, was then closed 

 without drainage. 



In the case of head injuries, Cuneo carried out the following 

 procedure early on the day that the wounded arrived : He outlined, 

 around the cutaneous wound, a large fiap with the convexity upper- 

 most; the wound was circumscribed by an incision and immed. 

 sutured. The site of the fracture was then cleaned, the splinters 

 removed, etc., and the generally abundant hemor. was arrested with 

 tampons. Two or three days afterward, if the patient was doing 

 well, the tampon was removed and the Aap was sutured without 

 draining. Wounds treated in this way gave a greater perccntage of 

 eures than that obtained by Cuneo with his old technic (cruciform 

 incision, cleaning of the site of fracture, and prolonged tamponing). 



Cuneo disclaimed the credit for originating the procedure de- 

 scribed, which is in general use at the front. He believed that the 

 recent circular addressed to the mil. physicians on the initiative of 

 Dr. Tuffier, extoling the use of Dakin's fluid, was, at least, futile. 



Dr. Tuffier replied that, although several hr. after the wound has 

 been made, a mechan. disinf., consisting of opening up, the removal 

 of foreign material, and the excision of mortified parts, was alone 

 sufficient to insure secondary reunion of a wound of war, such a 

 procedure is no longer sufficient after several days have passed. At 

 that time he beheves a ehem. disinf. necessary. Such a disinf. is 

 Dakin's fluid which, therefore, ought to be considered an excellent 

 topical application. 



Dr. Quenu believes that this statement of Tuffier's throws con- 

 siderable light on the question of dressing with Dakin's fluid. Tuffier 

 admits, in fact, that early primary reunion will take place without 

 any ehem. applic. whatever, provided the wound is cleaned during 

 the first hours after it has been received, and is freed from contused 

 parts and splinters. 



Dr. Broca stated that for a long time all surgeons have been 

 aware of primo-second. reunion of wounds, that is to say, reunion 



