Pads of sphagnum moss, sterilised by heat, are highly absorbent, and being economical are used when there is much discharge, and in cases where a leakage of urine has to be soaked up.

#Means adopted to combat Infection.#—­As has already been indicated, the same antiseptic precautions are to be taken in dealing with infected as with aseptic wounds.

In recent injuries such as result from railway or machinery accidents, with bruising and crushing of the tissues and grinding of gross dirt into the wounds, the scissors must be freely used to remove the tissues that have been devitalised or impregnated with foreign material.  Hair-covered parts should be shaved and the surrounding skin painted with iodine.  Crushed and contaminated portions of bone should be chiselled away.  Opinions differ as to the benefit derived from washing such wounds with chemical antiseptics, which are liable to devitalise the tissues with which they come in contact, and so render them less able to resist the action of any organisms that may remain in them.  All are agreed, however, that free washing with normal salt solution is useful in mechanically cleansing the injured parts.  Peroxide of hydrogen sprayed over such wounds is also beneficial in virtue of its oxidising properties.  Efficient drainage must be provided, and stitches should be used sparingly, if at all.

The best way in which to treat such wounds is by the open method.  This consists in packing the wound with iodoform or bismuth gauze, which is left in position as long as it adheres to the raw surface.  The packing may be renewed at intervals until the wound is filled by granulations; or, in the course of a few days when it becomes evident that the infection has been overcome, secondary sutures may be introduced and the edges drawn together, provision being made at the ends for further packing or for drainage-tubes.

If earth or street dirt has entered the wound, the surface may with advantage be painted over with pure carbolic acid, as virulent organisms, such as those of tetanus or spreading gangrene, are liable to be present.  Prophylactic injection of tetanus antitoxin may be indicated.

CHAPTER XIII

CONSTITUTIONAL EFFECTS OF INJURIES

SYNCOPE—­SHOCK—­COLLAPSE—­FAT EMBOLISM—­TRAUMATIC ASPHYXIA—­DELIRIUM
    IN SURGICAL PATIENTS:  Delirium in general; Delirium tremens;
    Traumatic delirium.

SYNCOPE, SHOCK, AND COLLAPSE

Syncope, shock, and collapse are clinical conditions which, although depending on different causes, bear a superficial resemblance to one another.