TREATMENT OF WOUNDS 93 



over with, the skin and whose cavity can be drained by 

 gravitation of the discharges. 



3. Wounds that cannot be drained by gravitation of the dis- 



charges. Open wounds. 



4. Venomous wounds. 



5. Punctured wounds. 



6. Gun-shot wounds. 



Aseptic Incised Wounds 



These are always surgical wounds, made in a prepared 

 field with a sterilized knife and touched only with steri- 

 lized objects — sponges, hands, solutions, and so on. In- 

 cised wounds accidentally inflicted must never be placed 

 in this category, as the sickle, razor, scythe, saber, or dag- 

 ger capable of inflicting them are not aseptic and there- 

 fore soil the tissues in the process of making. Although 

 these instruments may seem clean, they are actually 

 poisonous in many instances, depositing infections that 

 make the wound behave badly, and when closed with 

 sutures with no provisions for drainage they may often 

 end in a threatening if not fatal septicemia. 



Treatment. — The handling of this class of wounds is 

 indeed very simple. The first step is to close them up 

 completely with sutures so arranged as to bring and 

 maintain perfect apposition of all of the integuments — 

 skin, fascia, and muscle. Each integument — usually only 

 the skin is involved — is brought into very accurate con- 

 tact without, however, tightening any part sufficiently 

 to cause stitch necrosis. Sutures that have been boiled 

 fifteen minutes and then bathed in pure tincture of 

 iodin are the only sutures we use for this purpose. As 

 we have previously mentioned, these are recommended 

 because they are seldom soiled in the handling. 



The second step is the protection against infection dur- 

 ing the succeeding seven or eight days. The best method 

 is a varnish of coUodium applied layer after layer as 



