102 WOUND TEEATMENT 



it and thus produce a lot of debris that would have to 

 be cast off by the healthy elements beneath. Such treat- 

 ment is of course out of reason where the cavity must be 

 bridged over with the skin. Ordinary antiseptic ablu- 

 tions are inadequate; they never actually disinfect any- 

 thing. Every attempt we have ever made to bring this 

 surface of wounds into a safe state for suturing with so- 

 lutions has ended in disappointment. Disastrous suppu- 

 ration ensued and primary union of the skin was pre- 

 vented in every case. So uniform was this result that 

 we, like many others, fell back on open-wound treatment 

 for a time as much the best and safest plan of treating 

 practically all accidental wounds. It gave better results 

 than the closing of wounds that were harboring infected 

 tissues beneath the sutured integument. For a long time 

 we only sutured accidental wounds for policy's sake — to 

 appease a request — knowing all the while it was a use- 

 less procedure, and we always prepared for the inevi- 

 table breaking open a few days later, at which time the 

 real treatment of the wound began. 



We are now submitting such wounds to a mechanical 

 disinfection we have called "uncarpeting." That is, we 

 trim off all of the surface sheet-like, beginning above and 

 omitting nothing save possibly a synovial capsule, large 

 blood vessel, or an important nerve. These are, how- 

 ever, seldom encountered in wounds of this class. A 

 sharp scalpel, scissors, and tissue forceps are used, and 

 as the surface is loosened, the loose pieces are washed 

 off by a stream of sterilized water poured from a pitcher 

 by an assistant. The edges of the skin must be turned up 

 where it is loosened from the body and its under surface 

 submitted to the same trimming. Where there is nothing 

 loose to trim off, the wound is scraped with the scalpel 

 as the stream of water washes off the scrapings. The 

 edges of the skin must be included. Sometimes simply 



