Since the introduction of the injection cf antitetanic serum after these accidents, the amount of tetanus from this source has greatly decreased. It has also been almost eliminated among the European troops by the same procedure. Horse blankets or other articles which have been used around stables should never be allowed to come in contact with an open wound or a burned surface of the skin.

Treatment. When a person has received a lacerated wound which has been much soiled by dust or dirt, or a punctured wound from a nail or garden implement, the most important thing is to take the patient to a doctor and have him receive injections of antitetanic serum. This injection should be repeated at intervals of a week, until three doses have been given. The local treatment of punctured and lacerated wounds has already been described. Tetanus usually develops in from 6 to 16 days after the receipt of the injury, but occasionally may not appear for as long a period as three months. Gunshot wounds in which pieces of clothing have been carried into the flesh are apt to be followed by tetanus.

If tetanus does develop on board ship or in some other locality where a doctor can not be obtained, the patient should be placed in a darkened and quiet room. The bowels may be kept open by administering salts or castor oil daily. Give 20 grains of bromide of potassium with 10 grains of chloral every theree hours if necessary to produce quiet and allay pain. If attempts to swallow produce convulsions, the patient may be fed by small injections of beaten-up raw egg or other concentrated food by the rectum.

SPECIAL WOUNDS.

ABRASIONS.

Abrasions are very superficial wounds in which the outer layers of the skin have been rubbed or ground off by dragging the part forcibly over some rough surface.

Symptoms. Pain and redness. The affected areas are "raw" looking, and tiny drops of blood or serum may appear.

Treatment. If dirt has been ground into the injury it should be washed off with boric acid solution. If the surface is clean this is not necessary. A coat of diluted tincture of iodine, half strength or less may be applied, but ordinarily this is not necessary, and it is always very painful. Finally, dress with sterile gauze spread with boric acid ointment or oxide of zinc ointment.

BRUSH BURN.

When a rope slides through the closed hands very rapidly a combination of an abrasion and laceration is produced known as a brush burn

Treatment.-Apply sterile compresses of boric acid solution for several days. Then dress with sterile gauze spread with boric acid ointment.

SPLINTERS.

Small splinters may be removed from the flesh by means of a needle which has been passed once or twice through a flame and then cooled. Larger splinters may be extracted by passing a knife blade several times through a flame, cooling it, inserting the blade under the splinter and grasping the foreign body between the thumb nail and the knife.

WOUNDS CAUSED BY FISHHOOKS.

When the barbed end of a fishhook has entered the flesh, do not attempt to remove it by pulling it directly out. Such a procedure will cause great laceration and tearing of the tissues. The better plan is to depress the shank of the hook, push the point forward and onward in an upward direction, and bring it out on the surface at another point. The barbed end is then cut off with a wire cutter or file. The barbed end having been removed, the hook can be extracted by pulling on the shank without damage to the tissues.

BULLET WOUNDS.

Bullets make small, deep wounds which are generally classified as punctured wounds.

First-aid treatment.-Send for a doctor. If sterile gauze is available, cover the wound with that. Remember that there may be two wounds, one where the bullet went in, the other where it came out. If only one opening is seen, search for the other on the opposite side of the limb or body. Treat shock, if present.

After treatment.-If pieces of clothing have been carried into the wound and can be readily seen, remove them with a sterile instrument. Do not probe for the bullet. Swab the wound or wounds and surrounding skin with tincture of iodine and then apply a dressing of sterile gauze or other sterile material. Keep the injured part at rest.

If a bone has been broken by the ball, treat as a compound. fracture.

As soon as possible take patient to doctor for injections of antitetanic serum. All persons injured by firearms should receive these

injections.

PERFORATING WOUNDS OF THE CHEST.

Perforating wounds of the chest are severe injuries and are often followed by grave consequences, the lungs, heart, or large blood vessels often being damaged.

Symptoms.-The wound itself, pain, hemorrhage, and sometimes the entrance and exit of air into the chest which can be detected by a peculiar whistling sound heard at the wound during the act of breathing. The patient may spit up blood, and shock is almost always present.

First-aid treatment.-Send for a doctor immediately. Place the patient in a semireclining position and treat shock if present. Cover the wound with a large pad of sterile gauze.

After treatment.-Put the patient in bed; paint the wound with tincture of iodine; dress with a large compress of sterile gauze; place a tight bandage around the chest; and keep the patient quiet. Great swelling of the chest, neck, and even the face may occur, due to the entrance of air into the tissues, but in favorable cases this will subside spontaneously.

SCALP WOUNDS.

Scalp wounds are common and often result from a blow on the nead with a blunt object, such as a club or a beer bottle, the yielding scalp being caught between the rigid skull and the hard weapon.

First-aid treatment.-Check hemorrhage, if necessary, by laying a compress of sterile gauze on the wound and fastening it tightly with a bandage around the head. In severe cases a tourniquet may be tied around the forehead and head just above the ears. Send for a doctor. Treat shock if present.

After treatment.-Trim the hair close to the scalp for a wide area around the wound. Be very careful that the cut hair does not get into the wound. Paint the wound and surrounding scalp with tincture of iodine. Dress with dry sterile gauze. If the patient keeps disarranging the dressing by tossing the head during sleep, make a muslin cap with strings to tie under the chin. Hold the dressing in place by pinning it to the cap.

If the wound is large and gaps widely, it may be necessary to sew it up. If a doctor is not available and the bleeding can not be controlled by a compress with firm pressure, sewing up the wound will stop it. In sewing up a scalp wound be guided by the directions on page 193. Insert the needle to the bottom of the wound and tie the stitches tightly enough to check the bleeding but no tighter than necessary (fig. 153). Always leave a small drainage wick made of about eight strands of boiled thread in one end of the wound. Remove the drain in 48 hours. Take out the stitches in five days, and sooner if inflammation sets in.

WOUNDS OF THE ABDOMEN.

Shallow wounds of the abdomen are handled like similar injuries in other parts of the body, but deep wounds with escape of the bowels are very serious injuries and require special treatment.