I50 SOME TROPICAL TRAUMATISMS 



must at first be guarded, especially in Europeans, as it is impossible 

 to foretell how serious the intercurrent septic infection may prove 

 to be. 



The treatment resolves itself into two distinct categories: first, 

 the first aid when the rescue is effected; and, secondly, the usual 

 surgical treatment. 



With regard to the first aid, the usual methods for arresting 

 haemorrhage, combating shock, and carrying the victim are too 

 well known to require repetition, but the thorough washing of the 

 wound with water, even jungle water, would appear preferable to 

 leaving the poisons from the animal's teeth and claws in the wound. 

 We consider that a small first-aid surgical case containing antiseptics, 

 bandages, etc., should form part of the outfit of every sportsman, 

 and that antiseptics should be added to the water used to wash the 

 wound. 



As a rule the haemorrhage has more or less abated by the time 

 the man reaches a hospital, but any possible source of bleeding 

 must be at once attended to, and the wound thoroughly washed 

 and syringed with warm iodine lotion. Pieces of dead or sloughing 

 tissue may be removed, but it is better to defer any serious operative 

 treatment for twenty-four hours if possible, as it is very dangerous 

 to perform anything of this nature in the condition of shock usually 

 exhibited by the patient. The parts may be drawn together by a 

 suture if necessary, but very few of these should be inserted, and as 

 free drainage as possible allowed. Repeated and carefully applied 

 antiseptic dressings must be carried out. Antitetanic serum should 

 always be administered with the view of preventing possible tetanus. 



As soon as there is any suspicion that cellulitis has supervened, 

 free incisions must be made, and hot antiseptic baths, hot fomenta- 

 tions, or Bier's treatment must be applied. 



Amputation is necessary if spreading traumatic gangrene super- 

 venes, when it must be performed as high up the limb as reasonable, 

 as it is useless to do repeated operations first at low and then at 

 higher levels, while all the time the disease is spreading. Sinuses 

 require to be scraped and plugged with antiseptic gauze. 



When recovery is proceeding and the septic infections have 

 ceased, plastic operations are necessary to close the large wounds 

 left by the destruction of the tissues, while massage and douches 

 may be required to prevent joints from becoming stiff. 



As regards general treatment, the first requirement of the patient 

 is usually plenty of water to drink to relieve the urgent thirst from 

 which he suffers, and to dilute the toxins of the possible intoxication. 



At first the food should be of the lightest description — broths, 

 soups, and milk diet— and later the ordinary hospital diets may be 

 gradually introduced. 



With regard to prophylaxis, the natives often adopt simple 

 protective remedies, such as a bell and spear, or a stick and a small 

 axe, the latter being in use in districts infested by small bears. 

 For a sportsman it is important to thoroughly understand the habits 



