NINTH ANNUAL YEAR BOOK— PART X 431 
the dressing should be likewise, such as cotton gauze, sterile cotton, oakum, 
or tow. This dressing should be applied with uniform pressure at all 
times and secured by a bandage. Allow it to remain for a week or ten days 
if the wound is aseptic or if the dressing does not become loose or mis- 
placed or become drenched with secretions from the wound, or if pain, 
fever, or loss of appetite does not develop. The dressing should then be 
removed, the wound treated antiseptically, and a sterilized dressing ap- 
plied. 
HEALING UNDER A SCAIJ. 
This often occurs in small superficial wounds that have been kept 
aseptic. In order for a scab to form, the wound must not gap, secrete 
freely, or become infected with germs. The formation of scab is favored 
by astringents and styptics, such as tannic acid, iodoform, and 5 per cent 
solution of zinc chloride. In case of large hollow wounds that can not 
be dressed, such as fistulous withers, open joints, etc., antisepsis may 
be obtained by warm water irrigation with or without an antiseptic fluid. 
It should continue day and night, and never be interrupted for more than 
eight hours, for germs will then have gained headway and will be diffi- 
cult to remove. Four or five days of irrigation will be sufficient, for 
granulations will then have formed and pus will remain on the outside 
if it forms. For permanent irrigation the stream should be very small, 
or drop by drop, but should play over the entire surface of the v^ound. It 
is always better to heal an infected wound under a scab, or treat it as 
an open wound, than it is to suture the wound, thus favoring the growth 
of the inclosed germs and retarding ultimate healing. In the latter case 
pus may develop in the v/ound, form pockets by sinking into the tissues, 
and cause various complications. Such pockets should be well drained 
either through incisions at the bottom or by drainage tubes or setons. 
They should then be frequently syringed out or continuously irrigated. 
In case proud flesh appears it should be kept down either by pressure 
or by caustics, as powdered bluestone, silver nitrate, chloride of antimony, 
or by astringents, such as burnt alum. If they prove resistant to this 
treatment they may be removed by scissors or the knife or by searing 
with the hot iron. The following rules for the treatment of wounds 
should be followed: (1) See that the wound is clean, removing all foreign 
bodies. (2) For this purpose use a clean finger rather than a probe. (3) 
Arrest all hemorrhage before closing the wound. (4) Antiseptics should 
only be used if you suspect the wound to be infected. (5) When pus is 
present treat without closing the wound. (6) This may be accomplished 
by drainage tubes, absorbent dressings, setons, or continuous irrigations. 
(7) Protect the wound against infection while healing. 
LACERATED AND CONTUSED WOUNDS. 
Lacerated and contused wounds may be described together, although 
there is, of course, this difference, that in contused wounds there is no 
break or laceration of the skin. Lacerated wounds, however, are as a 
rule, also contused — the surrounding tissues are bruised to a greater or 
lesser extent. While such wounds may not appear at first sight to be as 
