PREPARATION OF INSTRUMENTS, ETC. 219 



Accident wounds are generally lacerated or contused and may contain patho- 

 genic bacteria. They should be promptly and carefully cleansed with sterile 

 salt solution, wiped with sterile gauze and, if necessary, scrubbed vigorously 

 with sterile soap and brush to remove all infectious dirt. When there is any 

 doubt of this being accomplished it is better to dress such wounds wide open, 

 filled with sterile gauze, for forty-eight hours or more. Retained blood-clots 

 form a good medium for the development of bacteria so that drainage for a 

 day or two is safer in doubtful cases. 



Injected wounds. There is no known method for promptly sterilizing in- 

 fected wounds vdthout destroying tissue. An infected wound, if the infection 

 be not too deep, may be sterilized by cauterizing with pure carbolic acid. 



Care must be exercised in the application of antiseptic solutions in infected 

 wounds for the antiseptic rarely penetrates as deeply into the tissues as the 

 bacteria are found, therefore further necrosis of tissue and mechanical cleanli- 

 ness are about all they accomplish. 



After-treatment of wounds. Close attention to details is important in the 

 technique of a first dressing after an operation. All instruments, irrigating 

 fluids, bowls, basins, etc., are to be sterilized. When the dressing is removed 

 the skin surrounding the wound should be cleansed by washing with salt solu- 

 tion or peroxide of hydrogen. The sutures or drainage should be removed 

 with sterile forceps, and fresh sterile dressings appHed. If a wound is found 

 infected, all accumulations of blood-clot, pus, etc., should be gently and care- 

 fully washed out, and free drainage provided. In the treatment of infected 

 wounds attention must be paid to maintaining mechanical cleanliness and 

 avoiding infection with some organism which may not be already present. 



It should be borne in mind that anything that tends to depress a patient's 

 resisting powers, such as prolonged exposure to cold during an operation, 

 loss of blood and infliction of a great degree of surgical shock, encourages 

 infection. 



