200 SURGICAL AFFECTIONS. 



prevent their tearing out. After the operation several thicknesses of anti- 

 septic gauze, if that can he obtained, shoiad he hound over the injured 

 parts, an d left undisturhed for three or four day s, at the end of which time 

 the stitches can he removed and the -wouna again dressed as before. When 

 the antiseptic gauze is unattainable, a compress of linen should be ap- 

 plied and kept damp -with a solution of carbolic acid, two drachms to a 

 pint of water. 



In the treatment of extensive and deep punctured wounds as In stabs, it 

 is to be remembered thatthe cut in the skin is liable to unite, and thus by 

 oonflnlng the discharge give rise to deep-seated abscesses. To prevent 

 this a small drainage tube can be introduced, and left in the wound for 

 two or three days and then removed permanently, or after being cleaned 

 and disinfected be again returned, and shortened from time to time as 

 the healing from the bottom progresses. A dressing of the antiseptic 

 gauze should be kept lightly and constantly applied. When the proper 

 tubing cannot be secured, a cord made of several strands of ligature silk 

 can be substituted. In smaller punctured wounds It is wise to bandage 

 them with some degree of fli'mness, and keep the parts at rest as much as 

 possible; then if pain, heat, and swelling foTlow, an abscess has resulted; 

 an incision should be made and poultices applied. 



Lacerated wounds are to be dressed antiseptlcally, and treated much 

 the same as incised wounds after being stitched. Those from bites should 

 be first freely cauterized. 



Contused womids If superficial and deserving of treatment, generally 

 do well under cold applications. When the deeper tissues are severely 

 injured and the vitality of a portion is destroyed and must separate 

 from the healthy flesh, poultices should be applied to hasten the slough- 

 ing process and be persisted in until the wound Is clean and healthy, after 

 which it can be treated as an ulcer, the oxide of zinc ointment being 

 appropriate Old, indolent, suppurating wounds which heal slowly need 

 stimulating occasionally; for which purpose caustic can be used, not ex- 

 tensively but simply touched here and there over the entire sore. 



When deep wounds or abscesses have not been thoroughly healed from 

 the bottom through a defect in bandaging, or in providing proper outlets 

 for the discharge, a fistula results. This is a narrow canal opening on the 

 surface and leading to the suppurating cavity. 



The treatment is to enlarge the opening; keep it open and syringe out 

 the cavity with a strong solution of the nitrate of silver, grains thirty to 

 water an ounce. 



