But whatever may be the infection, it is possible to subdue it by accurate surgical and antiseptic treatment. This should be done as early as possible, preferably before the first eight hours after the injury. An X-ray pic ture indicates the bone lesion and also the location of foreign bodies. The operation which follows consists of wide opening of the wound; of the complete excision of the walls of the wound; of the removal of foreig-n bodies, and of the resection of bone splinters. This mechanical cleansing permits the removal at the same time of any necrotic tissue and bacteria. After this operation it is in many cases possible to close the wound immediately. But if there remains a doubt as to the pres ence of dangerous bacteria within the injured part, it is preferable to keep the wound open, to malce bacteriological examinations and to close it only after knowledge has been ob tained of the result of these bacteriological examinations. If a wOund is infected, it is best to keep it opan and to sterilize it by an antiseptic method, which permits secondary closure after several days.
The old antiseptic methods have proved themselves insufficient. Carrel and Dakin thought that the main reason for the failure of these methods was their inadequate applica tion. Indeed, contact of an antiseptic sub stance with a wound only once a day produces sterilization for only a few minutes, because the secretions quickly combine with the anti septic, thereby destroying its efficacy. The Carrel-Dakin method consists of the applica tion, renewed every two hours, of a strong antiseptic, non-toxic and non-caustic, but hav ing the property of dissolving necrotic tissue.
This substance must reach every part of the wound, for which purpose tubes especially pre pared are placed in all the interstices of the injury, as carriers of the antiseptic fluid.
Experience has shown that with the use of hypochlorite of sodium, in the way described, it is possible quickly to sterilize every kind of wound, and Dehelly and Dumas have shown the feasibility and necessity of closing these wounds after sterilization, instead of allowing them to cicatrize spontaneously.
Dakin and Dunham, endeavoring to simplify the technique, prepared another antiseptic, dichloramine-T dis.solved in a chlorinated paraffin oil. This preparation permits the slow decomposition of the antiseptic in contact with the secretions of the wound, thus diminishing the necessity for renewal of the antiseptic on the surface of the wound. Good results have been reported from the application of this com pound.
To resume: Considerable progress was made from the beginning of the war until its close in the treatment of the wounded. This was due, first, to the early treatment of the injured; second, to the conquest of the infec tion by the Carrel-Dakin method; third, to the perfected surgical cleansing of the wounds; fourth, to the secondary closure proved neces sary by Dehelly and Dumas, and, fifth,. to the work of Gaudier, showing the possibility of cleansing a wound thoroughly by surgical means and closing it immediately after the first operation. The result of this progress was that 80 per cent of the wounded were returned without disability and after short period of treatment tcs the active =Mary forces.