are called germicides. Tincture of iodine and carbolic acid are good germicides. The attempts to kill germs by heat or chemicals is known as disinfection. Certain substances, while they are not able to kill bacteria to any great extent, can prevent them from growing, and such chemicals are known as antiseptics. A solution of boric acid is a good illustration of an antiseptic.

Boric acid.-Boric acid is a white powder which is extensively used in medicine. A saturated solution is made by stirring a heaping tablespoonful of the powder into a pint of hot water. This solution is soothing and cooling to the tissues and is often used to irrigate dirty wounds, to wash out the eyes, as a mouth wash, and also on compresses to apply to burns and inflamed wounds. Boric acid in solution is nonirritating to the tissues, prevents the development of bacteria, and is not poisonous. Boric-acid ointment is an excellent application for burns and abrasions. It is prepared according to the following formula.

Boric acid in fine powder, 1 part; paraffin, 1 part; white petrolatum, 8 parts. Melt the paraffin, add the white petrolatum, and heat gently for 10 minutes. Then gradually add the hot liquid to the boric acid in a warm pan and stir the mixture thoroughly until it hardens.

In an emergency a fair substitute can be improvised by thoroughly mixing 1 part of boric acid powder with 10 parts of vaseline or petroleum molle.

DISINFECTION OF WOUNDS.

It was formerly the custom to attempt to destroy any bacteria which might have gotten into a wound at the time of the accident by washing the injury with solutions of carbolic acid, bichloride of mercury, hydrogen peroxide, or similar substances. It has been demonstrated, however, that it is practically impossible to kill all the germs in this way and that if the solutions are of sufficient strength to kill the germs that they will do harm to the tissues. In first-aid work wounds therefore should not be irrigated with such solutions unless they are very badly soiled with dirt or if it is necessary to wash out a number of small foreign particles. If the wound is reasonably clean it is much better to simply apply tincture of iodine. This is done by taking a clean match or toothpick, twisting a small amount of cotton around the end to make a swab (fig. 144), dipping the swab in the iodine, and applying a light coat first to the wound and then to the surrounding skin. The iodine will destroy most of the germs and do no harm to the tissues. Experience has shown that in first-aid work wounds which have been treated with iodine in this way do better than those which have been washed out with watery solutions. If the skin of the hand, foot, or part which

happens to be injured is very dirty, it is permissible to dampen a cloth slightly with soap and water or gasoline and to wipe off as much of the dirt as possible from the skin some distance away from the wound, being careful, however, to avoid touching the wound itself or the area immediately adjoining it. Under no circumstances should ordinary water be put into a wound, nor should the cleansing cloth be sufficiently wet to permit the chance of any of the cleansing fluid running into the wound. After the tincture of iodine has been applied the wound should be dressed and the dressing held in place with a bandage or other appliance.

Tincture of iodine is sometimes used just as it comes from the drug store, but it is very much better to dilute it. When buying tincture of iodine for application on wounds it is advisable to always have the druggist add an equal amount of grain alcohol to the regular preparation, making a half-strength tincture. This diluted solution is very efficient for killing bacteria and is not so likely to irritate the skin as the full strength. The weaker solution should be always used for applying to wounds when available. It is also wise to allow the alcohol to evaporate for a few moments before applying the permanent dressing.

Wet dressings should not be placed on skin which has been recently painted with tincture of iodine, as irritation is likely to result. Iodine may be removed by washing with alcohol. The irritating action of too much iodine on the skin can be checked by applying thin, cooked starch paste.

WOUNDS WHICH ARE SOILED WITH DIRT, SAND, OR FOREIGN

BODIES.

Reference has already been made to the fact that it is undesirable to wash wounds out with solutions unless absolutely necessary. When dirt and other substances have gotten into the injury, however, it is necessary to remove them and we must take the lesser of two evils and apply solutions. Large particles of dirt may be picked out with a forceps which has been boiled, or with the fingers which have been specially washed and sterilized as described on page 184.

In an emergency, if it is necessary to place the hands in the wound without washing, they should be covered with several thicknesses of sterile gauze as this will assist in preventing infection of the wound. After picking out the gross particles the dirt may be removed by flushing the wound with a suitable solution and scrubbing with pieces of sterile gauze. For this purpose use freshly boiled and cooled boricacid solution made by stirring a heaping tablespoonful of powdered boric acid into a pint of hot water, or a 1 to 5,000 bichloride of mercury solution, or a 3 per cent compound cresol solution. Pieces of gauze may be boiled in the solution and used as swabs. These solu

tions should be poured into the wound from the pan in which they have been prepared. If dry sterile gauze is available the interior of the wound should be dried as well as possible after the dirt has been removed. It is well to allow it to remain exposed to the air for a short period to further the drying process. Be careful about disturbing blood clots in wounds because this may start bleeding afresh.

HYDROGEN PEROXIDE.

The practice of applying hydrogen peroxide to fresh wounds is not recommended as a routine practice. It causes a great deal of pain, wets the wound, and is not an efficient germicide. Hydrogen peroxide may be used sometimes to check hemorrhage or to clean up an old leg ulcer, but it should not be applied to other wounds except on advice of a physician.

DRESSING AND TREATMENT OF WOUNDS.

As soon as a wound has been received the first procedure is to determine whether it will be necessary to take active steps to check hemorrhage (p. 205). The clothing should be removed or rolled out of the way so as to give a good view of the injury. In the great majority of cases the bleeding will be slight and will cease spontaneously in a few moments. If the wound is more than a slight cut, a doctor should be summoned. Pending the arrival of the physician, the wound is left alone, nothing being done except to keep the patient still unless it is necessary to check hemorrhage. The patient should rest in a comfortable position and be kept quiet so that the clothing does not rub over the injury, thus introducing bacteria. The wound may be freely exposed to the air without risk for an hour or two, provided nothing is allowed to touch it.

If it will be a long time before medical help arrives, the wound should be covered with several thicknesses of sterile gauze or as clean material as can be obtained in order to protect it from accidental contact with the clothing or other objects. If the patient has to be taken a considerable distance, a regular dressing should be applied and fastened in place with a suitable bandage.

Dressing of wounds.-The best dressing for a wound is sterile gauze. Four or more thicknesses of the gauze should be used, depending upon the extent of the injury and the amount of oozing. The gauze should be folded into such a shape as to cover the wound completely and extend for some distance over the sides. It is much better to have the dressing too large than too small. The purpose of the dressing is to protect the wound and to keep out germs. In large wounds a layer of sterile absorbent cotton is generally placed over the gauze. This can be omitted in small wounds.

Never put cotton directly next to a wound. The blood and discharges will harden in the cotton and cement it fast so that the wound may be torn open when it is necessary to remove the covering.

The dressing must be held in place by some method, and this is generally done by a bandage. The bandage need not be sterile if the wound has been properly dressed. For instructions concerning bandages and their application see page 222. The dressing on an ordinary wound should be left on for at least four or five days, if it feels comfortable and no pain or throbbing develops in the injury. If the bandage becomes loose, it should be replaced without disturbing the dressing. If pain develops in the wound and it begins to throb, the dressing should be removed and the wound examined. It has probably become inflamed and will require special treatment. For the treatment of inflamed wounds see page 194.

FIRST-AID PACKETS.

Small packages properly sealed and protected containing sterile materials for dressing a wound are carried by all soldiers and are often kept on hand for emergencies in factories, on trains, etc. Various kinds of first-aid packets are on the market, but an excellent one is supplied by the American Red Cross. The American Red Cross Textbook on First Aid describes the Red Cross first-aid outfit as follows:

In each of these outfits is found a long gauze bandage, with a compress of gauze sewn to it in the center, a triangular bandage printed so as to show how to apply it, and two safety pins.

The directions, which are also found inside the case, are as follows:

"GAUZE BANDAGE WITH COMPRESS.-If there is a wound or any injury in which the skin is broken, this bandage and compress are used by unfolding the bandage, being careful not to touch the inner surface of the compress. The compress should then be placed directly on the wound or injury, and held in place by wrapping the ends of the bandage around the limb in opposite directions and tying them or pinning them in place. With a very large wound which the compress will not cover, apply it to the middle of the wound and wrap the bandage around as before. In this case be careful not to touch any surface of the bandage which is placed on the wound. In case there is no wound, this bandage may be used like an ordinary bandage to hold splints in place, etc."

Such packets are useful for soldiers and travelers, but every home should contain at least a small supply of sterile materials suitable for dressing burns and cuts. The following are suggested as most important:

Five yards of sterile gauze, in half yard packets, if obtainable.
One-fourth pound of sterile cotton.

One dozen assorted sterile gauze bandages-from 1 inch to 3 inches. One-fourth pound of vaseline. Petroleum molle is just as good and generally much cheaper.

One ounce of tincture of iodine (half strength) in a glass-stoppered bottle.

One-fourth pound of boric acid.

FURTHER TREATMENT OF WOUNDS.

Small cuts-Bleeding is beneficial as it serves to wash out bacteria. After hemorrhage has ceased, paint the wound and the surrounding skin for a considerable distance with a light coat of iodine as above described. Apply a dressing of sterile gauze or freshly laundered muslin and hold in place with a bandage. A sterile gauze bandage makes a convenient dressing for small injuries around the fingers or hand. A piece of the bandage may be folded into a compress, or the bandage alone simply wrapped around the finger, care being exercised so that the part which goes next to the wound is not touched by the operator.

Large cuts. These are apt to bleed freely, but unless an artery or large vein has been opened, the hemorrhage will in most cases cease of itself.

First-aid treatment.-Send for a doctor. If the blood comes in spurts apply a tourniquet. For the treatment of hemorrhage, see page 205. While waiting for the physician make the patient comfortable and see that the clothing does not come in contact with the wound. If the patient has to be transported before medical help can be obtained, cover the wound with a number of thicknesses of sterile gauze, boiled dry muslin, or similar material. If these are unobtainable, use some freshly laundered article such as a clean handkerchief, towel, or napkin. Hold the dressings in place with a bandage.

Treatment when no doctor will be available.-After bleeding has ceased, apply a light coat of tincture of iodine to the wound and surrounding skin with a cotton swab. Dress with sterile gauze or simi lar material as directed above.

. In an ordinary wound no effort should be made to remove the clotted blood from the wound and the skin immediately around it. The blood is aseptic and when dry makes an excellent protection for the tissues. The dressing should be applied over this material without disturbing it.

LACERATED WOUNDS.

Most of these wounds are infected with bacteria at the time the injury is received, but severe bleeding is rare.

First-aid treatment.-Check hemorrhage if necessary. Send for a doctor. Cover the wound with a sterile dressing making no attempt to disinfect it. While awaiting the arrival of the physician, make the patient as comfortable as possible and treat shock, if it is present (p. 220). If no sterile dressing is available, leave the part exposed to the air but take care that nothing touches the wound. Treat crushes of the hand, arm, foot, or leg in the same manner. 129054°-19 -15-16