THE TREATMENT OF CUTS, LACERATIONS, AND BRUISES This is done according to the general rules of asepsis and antisepsis. Cuts should be washed when possible in running water.
In letting smaller wounds bleed, naturally not too much, and in suck ing out stab-wounds we possess an excellent preventive against infection. The flowing blood will with more certainty wash away the germs from the tissue-pockets than could be done with external or chemical measures.
With the use of antiseptics we must be very careful, especially with carbolic acid, which is the favorite amongst the public, because the child's system is very sensitive to it (necrosis).
After removing splinters, etc., we close the wound when we can assume that it is not infected; the suture is painted with tincture of iodine and over this it is advisable to paint some alcoholic resinous solu tion to prevent the spreading of the germs on the skin.
Splinters of glass and metal can be shown in the skiagram. In injuries with splinters of wood which have come in contact with the soil we must always think of tetanus, especially in regions where this is prevalent. Prophylactic injections of antitetanus serum, best intra- and perineu•ally, in the nerves supplying the injured part and injected proximally of the injury, can never do the children any harm and may save the physician from grave reproaches (in severe injuries intraspinal injection, lumbar puncture). [The foregoing applies also to injuries from powder and fireworks, especially the "Fourth of July" injuries which are still far too frequent in the United States.— THE TRANSLATOR.] Soiled wounds of any size are cleansed and then dressed with balsam of Peru. At the same time we may try by protracted congestion to limit the infectious process and to shorten it and in some cases we can surely succeed. Attempts to prevent or remove infection by disinfecting and brisk rubbing out of the wound must be avoided. All these measures
do a great deal more harm to the tissues of the edges of the wound than to the germs which arc well hidden in the recesses of the lymph-spaces.
In larger lacerations, which are especially frequent on the hands, we must be as conservative as possible. Only those pieces which separate spontaneously are taken off at the line of demarcation; exposed and loose splinters of bone are removed, severed muscles, tendons, and nerves are united. More extensive primary plastic operations should be post poned on account of the danger of infection. The edges of the wound arc covered with balsam of Peru, which acts as a disinfectant and also prevents putrefaction of the (lead tissues. Continued congestion is applied to the injured limb and it is placed on a moderately warm thermophore. It is almost marvelous to find that tissues which had been considered as lost will recover under this treatment and to observe the power of regeneration of function of the youthful body.
In a child of two years the right wrist was cut through entirely by the knife of a feed-chopper except for a strip 1 cm. wide and a few mm. in thickness at the ulnas side; fortunately the ulna• artery, protected by the flexor ulnaris, was preserved in this strip. After uniting all ten dons, nerves, and the skin, this hand, which at first was livid, recovered entirely under the treatment just described.
We must naf urally employ every means to avoid permanent deform ities and disturbances of function (proper posture on splints and treat ment of fractures). Only when the danger of infection is passed do we attempt to improve the function by plastic surgery.