222 MISCELLANEOUS 



it should be dressed twice a day. Where proud flesh appears, it should 

 be kept under by the application of nitrate of silver; again if the wound 

 is unhealthy-looking, and the healing process is retarded, a slight applica- 

 tion of nitrate of silver will often stimulate it to healthier growth. 



"In all cases where the wounds heal by the process of granulation it 

 is absolutely necessary that the repairing process should begin at the bot- 

 tom, and so gradually close the wound. Should it occur at the surface, the 

 pus will be imprisoned, burrow between the muscles, and find an exit or 

 exits elsewhere in the shape of abscesses; or the pus will form sinuses, which 

 will necessitate making large incisions. All wounds should be examined 

 well for the purpose of detecting the presence of foreign matter, and again 

 hemorrhage (bleeding) must be stopped before suturing. 



"In puncturd wounds, the wound should be explored by means of a 

 silver probe, so that the exact extent of the injury can be ascertained, and 

 foreign matter removed. If this latter is overlooked, the result is often 

 blood-poisoning and death. Punctured wounds must always heal by granu- 

 lation; where there is any suspicion of foreign matter, always have re- 

 course to a poultice. 



"Contused wounds are generally successfully treated by poulticing and 

 fomentations, but if the injury is severe, sloughing may take place. The 

 final healing is by granulation. Always bear in mind to keep the wound 

 clean. 



"To summarise the general treatment of wounds. First stop the 

 bleeding, remove the hair and examine for the presence of foreign matter, 

 and where this exists remove it. If there is any doubt about it, apply a hot 

 poultice night and morning until satisfied that the wound is cleansed; 

 where it is practicable, always insert sutures to keep the edges together. 



"As I have already said, dry dressings are the most successful, such 

 as carbolized tow, and gauze (Listers' carbolized gauze) with a pledget of 

 tow over it, kept in position by a bandage. In some situations this is not 

 possible. The wound should be dressed night and morning with carbolic 

 lotion: Carbolic acid 1 part, water 20 parts, with a little glycerine added. 

 Or a saturated solution of boracic acid will do equally as well." 



