TREATMENT OF WOUNDS 69 



that wound treatment begins in the preoperative de- 

 liberations over a proposed surgical subject, for if the 

 wound will not heal, no operation is indicated. 



Preoperative Treatment of Wounds 



Under this somewhat irrelevant title is included a 

 consideration of those systematic conditions which miti- 

 gate against the healing of wounds made by the sur- 

 geon and those accidentally inflicted; the influence the 

 general health will have upon the behavior of a pro- 

 posed surgical wound; the condition under which the 

 patient must live during healing ; and the amount of 

 intelligent after-care it will be possible to administer. 



The bearing of the health and especially the vigor of 

 a wounded patient upon the healing of a wound has 

 too often been ignored. In a large city, where horses 

 are often reduced to a pronouncd state of general en- 

 feeblement from hard work, or from hard work and pri- 

 vation combined, the influence of this element in, .the 

 behavior of wounds is most appreciated. The serious 

 nail prick, implicating the pedal synovials, for example, 

 will respond to active treatment in the vigorous subject, 

 but will prove fatal in the weak. In the strong, wounds 

 are inclined to have only a local effect, while in the 

 weak, bacteria and their metabolic products are almost 

 certain to tend to generalize and cause such grave com- 

 plications as septicemia, pyemia, and embolic pneumonia. 



The management of wounds must, therefore, begin in 

 the preoperative deliberations. We must know first if 

 the patient is fit to withstand a given ordeal, and then 

 plan accordingly. I know of no one element that works 

 so much harm in animal surgery as that of operating 

 upon the weak subject. Whether the enfeeblement is 

 due to disease or other influences does not matter, the 



