PREVENTION, SYMPTOMS AND TREATMENT 377 



water), and the bowel returned to the belly. The abdominal wall 

 must then be closed in layers with chromic catgut, using, however, 

 interrupted silkworm gut for the approximation of the skin. It is 

 wise to insert also several silkworm gut sutures, through all layers 

 (except the peritoneum) of the abdominal wall at certain points, to 

 reinforce the layer sutures and prevent hernia. The wound may be 

 sealed with iodoform and collodion (1-8), and covered with sterile 

 gauze and adhesive plaster and band about the belly. 



Punctured Wounds. — The rule is to clip the hair and disin- 

 fect the dry skin with tincture of iodine, and not to probe or disturb 

 the wound unless it contains a foreign body or it becomes necessary 

 to pack the wound or ligate a vessel to arrest hemorrhage. The 

 wound should then be sealed with iodoform and collodion ( 1-8) and 

 covered with gauze wet in corrosive sublimate solution and bandage. 

 Punctured wounds with a manure fork, harrow tooth or nail are 

 likely to give rise to tetanus, and a prophylactic dose of tetanus anti- 

 toxin should be given (see Tetanus). If signs of inflammation ap- 

 pear, with local heat, ,pain and swelling and general fever, then the 

 wound must be opened to liberate pus, or Bier's hyperemia (see 

 p 278) may be tried. 



Gunshot Wounds. — The indication for treatment is as for 

 punctured wounds — sterilization of external wound, and sealing 

 with wet antiseptic dressing and rest. Probing is to be avoided. If 

 a foreign ibody has been carried in by the missile, then its removal 

 will probably be required, but not so in the case of a bullet unless 

 it is subcutaneous. If local or general infection ensue then incision 

 becomes necessary to afford drainage, but not to discover the 

 missile. 



Joint Wounds. — When there is a small perforating wound 

 of a joint the surrounding area should be sterilized as recommended 

 for punctured wounds. The immediate point of perforation should 

 be subjected to prolonged irrigation (1 to 1,000 corrosive solution), 

 but the wound itself should not otherwise be interfered with. Then 



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