Free incision, when once the wound showed evidence of infection, care in removal of any material that might have been left behind, brought out different views as to irrigation, drainage and the use of antiseptics. There has been great discussion regarding the use of the latter, some surgeon writers coming to the con clusion that any sterile preparation — and keep ing the part clean — was sufficient.
The Congress of American Surgeons and Clinical Surgeons was arranged with great care by its officers for 1918, and many surgeons con nected with the armies abroad accepted invita tions to prepare papers and discussions on the classification and treatment of wounds, In consequence of the epidemic of influenza this meeting had to be abandoned, which was a great disappointment to all; however, the for eign delegates who did come visited a number of our larger cities, attended hastily called meetings and gave clinics, that, later, as they appear in our medical journals, will add greatly to our present literature on military surgery.
As has been stated, it is impossible at the present time to make any positive report on what is ultimately to be shown as the better treatment of all wounds; however, this can safely be said: At dressing stations, so far as time and the wound will permit, such dressings should be applied as will enable the patient to reach the base hospital. More serious wounds are to be treated at the evacuation hospital, such as the control of hemorrhage, amputation that may be necessary, all wounds that can be, and time will allow, to have more permanent dressings, in order to transport distances to the base hospital with as little handling and dis turbance of the dressings as possible. Here
should be used prophylactic doses of the tetanus antitoxin in such wounds as seem to require it. On arrival of the wounded at the base hospital all cases to be carefully inspected, those found infected to have free incision, all necrosed tis sues, or foreign substances, such as pieces of clothing, dirt, fragments of missiles, anything that may conduce to the spread of infection, removed, and bringing the wound into a better condition for immediate union. Also in these cases there enters the application of the drain age tube, and the beginning of the Carrell method of treatment, the Dakin antiseptic solu tion, the use of the newer antiseptics, such as dichloramin-T., chlorinated eucalyptol, chlori nated paraffin oil, aceiflavin and proflavin, bril liant green and other methods of antiseptic dressings. Wright's theory of thorough irriga tion and the 20 •per cent solution of picric acid in alcohol have been used with good success in the treatment of sepsis. In the cases of gas infection, or gas gangrene, emphasis is placed upon long and free incisions, amputations with out any attempt at bringing the flaps together and also the use of the serum treatment. Keen's book on "Treatment of War has afforded much valuable information.
In the treatment of convalescents it is very much to the credit of our government that the wounded are being brought as near to their homes as possible, and one has but to notice the almost daily arrival of steamers to observe how faithfully this is being carried out.