PREVENTION, SYMPTOMS AND TREATMENT 275 



drainage; otherwise drainage should be introduced to the most 

 dependent part of the wound and the wound closed in the remaining 

 parts by sutures. If infection occurs it is always easy to pull out 

 the sutures and reopen a wound, but it is impossible to secure first 

 intention if the wound has become infected. It is therefore better 

 to close a wound without drainage if circumstances appear to favor 

 first intention. If a fresh wound is much soiled by contact with 

 dirt it may be disinfected in part by the application of pure phenol 

 over its entire surface and then by pure alcohol, which prevents the 

 irritation of the carbolic acid ; or the tincture of iodine may be used, 

 and the wound packed with iodoform gauze. Wherever it is pos- 

 sible the wound should be dressed and bandaged as advised above 

 for operative wounds. 



Old and contused wounds should be treated by the free'appli- 

 cation of aseptic gauze soaked in a two per cent, solution of lysol 

 or 1 to 3,000 corrosive sublimate solution. This should be covered 

 with oil silk or rubber dam and bandage and renewed each day until 

 the inflammatory and septic character of the wound has abated. 

 When, owing to location, bandaging is impossible, the wound should 

 be frequently bathed with hot lysol or corrosive solution and cov- 

 ered with iodoform and tannic acid (1-5), or treated as advised 

 for granulating wounds. Unhealthy granulations in old wounds 

 and ulcers should be removed by a thorough curetting or by touch- 

 ing with lunar caustic stick. 



Moreover, in granulating wounds the daily application of 

 carbolic acid in glycerin (1-12 to 16) as a regular dressing, or 

 gauze saturated in Peruvian balsam, are indicated. In chronic 

 ulcerations — as decubitus — the use of equal parts of naphthalin and 

 iodoform, or an ointment containing one part of silver nitrate, five 

 parts Peru balsam, and twenty parts vaseline, are of benefit, espe- 

 cially where the wound can not be covered with a dressing and 

 bandage. In unhealthy, sloughing ulcers, thorough removal of the 

 dead tissue by curetting is desirable. Wound healing in old ulcera- 



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