WOUNDS FROM SHARP OBJECTS. 131 
should be shaved and disinfected; then the raw surfaces should be 
purified as indicated. 
The condition of the wound justifies the attempt to have immediate 
union. If the blood flows yet in abundance, and in streams, it can be 
stopped by affusions of cold boiled water; if it escapes from a large 
blood vessel, a small vein or artery, hemostasis should be made with 
one or several catgut ligatures, which will be absorbed. The ends of 
the catgut should be cut close to the stopper knot; and there the 
edges of the wound should be brought close together, and held in posi- 
‘tion by sutures, carefully placing in coaptation the similar portions of 
the two juxtaposed-surfaces. Sutures with close stitches made of silk 
threads, or silk-worm gut, are preferable to metallic sutures. With 
deep wounds, the mortified parts should -be avoided, by adding deep 
sutures made with catgut to the superficial, These deep sutures will 
hold the edges of the wound close together, in their entire thickness, 
for a length of time sufficient to permit adhesion to take place. We 
will mention, merely for the sake of calling to memory, the sticking: 
bands and uniting bandages, all of which are inferior to sutures and. 
are therefore left aside. According to the region, the wound should. 
be closed with iodoform collodion or covered with a wadding dressing,. 
after having been powdered with iodoform or with a coat of iodoform 
vaseline. When once the union is obtained, the sutures not absorbed. 
should be removed.. 
In wounds with exeresis, interrupted suture has the inconvenience 
of producing on the edges too severe a tension ; and often the tissues 
are cut by the stitches. Twisted suture holds the borders of the wound 
close together and is advantageous for solutions of continuity which 
divide entirely the walls of natural openings or of some delicate struc- 
tures (lips, nostrils, false-nostrils, eyelids, or sheath). When the 
dieresis involves deep down an aponeurosis, a tendon or a bone, a 
tendinous sheath, a synovial membrane, one of the great serous struc- 
tures, or one of the visceras they contain, in general, immediate treat- 
ment does not present other difficulty than a minute antisepsis and 
occlusion. 
If adhesive reunion has failed, and the wound suppurates, it should 
be disinfected with a strong antiseptic solution (corrosive sublimate 1 in 
1000, creolin or carbolic acid 4 or 5 %, chloride of zinc 8 or 10 %) or with 
atomizing or baths of a less concentrated solution ; it should be covered 
with a dressing, or left exposed. Experience has shown the superiority 
of these agents over alcohol, camphorated alcohol, or tinctures, ‘even 
those of arnica or glycerine. To assist the escape of the pus isa 
principle which is more strictly followed to-day than ever before. At 
times, it is necessary to drain the part with a fenestrated tube fixed to 
the borders of the wound by a stitch of suture; when the wound is 
