11)17] on The Treatment of War Wounds 4:) 



would drive back and expel invading micTol)es. It would also pre- 

 vent the conditions in the walls of the wound becoming unwholesome 

 to leucocytes. The continuous outpouring of lymph would also 

 effectively combat the corruption of the discharges in the cavity of 

 the wound. And lastly it would prevent any drying up of the 

 wound. The effect of holding up the emigration of leucocytes would 

 be to prevent the corruption of the wound discharges. You will 

 remember that leucocytes, breaking down, furnish the trypsin which 

 corrupts the discharges. 



We have in a hypertonic solution the therapeutic agent we require 

 for these purposes. The proper way of using it is to apply to the 

 wound three or four layers of lint thoroughly soaked in 5 per cent, 

 salt solution : to impose upon these, as a reinforcement, three or 

 four more layers of lint, thoroughly soaked in saturated salt solution,"' 

 and then cover the whole with jaconet, or other impermeable material. 



RE3IEDIAL TREAT3IEXT. 



I now pass from discussion of the method of preventing the set- 

 back that occurs in transport to the discussion of its remedial treat- 

 ment. The set-back will, as we have seen, have given us either a tryptic 

 suppurating wound or a dry slough-covered wound. In each case 

 the first item in treatment will be to get a clean surface. For that it 

 will, in the case of the tryptic suppurating wound, suffice to wash 

 away the tryptic pus. In the case of the desiccated slough-covered 

 wound we must get rid of the sloughs. The rational way to do that 

 will be by cleansing digestion. Such cleansing digestion can be 

 obtained by treating the wound with hypertonic salt solution. This 

 will, as we have already seen, break down leucocytes, setting free 

 trypsin, and then the free trypsin will rapidly, and especially rapidly 

 if hypertonic salt becomes diluted, amputate the dead from the 

 living tissues. Let us note that what we set out to do hx the use 

 of hypertonic salt solution is only to achieve more rapidly, and, as 

 we shall see, with less risk of infection, what putrefaction and the 

 destruction of leucocytes l)y microbes would, if we allowed things 

 to run their course, spontaneously accomplish. The second item of 

 treatment in each case will be to combat the infection which has 

 found a lodgment in the walls of the wound cavity. To deal with 

 this we require an outpouring lymph stream, obtained by hypertonic 

 salt solution. 



If the train of reasoning I have laid before you is correct, it will 

 follow^ that hypertonic salt solution is the agent we require Ijoth for 

 preventing the set-back due to interruption of treatment in transport, 

 and also for remedial treatment. 



* The saturated solution diluted with 6 parts of water will give us our 

 5 per cent. salt. 



Vol. XXII. (Xo. Ill) e 



