It is not advisable to bring the edges of the wound together; the main object is to overcome the spread of infection and the toxic absorption of the wound product.
When the symptoms are severe moist dressings, in the form of compresses dipped into 1-3,000 bichlorid, are to be preferred, changing them every hour.
Internally it becomes necessary to reduce the temperature and to overcome the toxemia.
For the temperature quinin is the best agent. In milder cases it can be given in tonic doses, associated with antifebrin, with or without morphin, to quiet the patient. In severe forms quinin must be pushed, giving as much as twenty grains at a dose, to be repeated as necessary. A saline purge, magnesium sulphate in full doses, is useful to eliminate the ptomains.
The strength of the patient must be supported by the free use of stimulants and frequent small quantities of nutritious food. Milk with whisky is excellent. Peptonoids and beef juice are given several times in the day.
Favorable symptoms are heralded by the lowering of the temperature, the abatement of toxic symptoms, the reduction of the edema, and the deep redness, as well as the softening of the hard and painful edematous walls of the wound, followed by the breaking down of more or less tissue with the production of pus.
GANGRENE
Gangrene in these cases is often due to undue bruising or pressure on the parts during operation, and otherwise to the tension of sutures. It is best to allow the gangrenous mass to remain, keeping it aseptic by antiseptic measures, as it is often found that only the superficial layer and the edge or edges of the wound have suffered.
As demarcation is well established the gangrenous portions may be removed with the dressing or small seizing forceps. Walcher’s pattern of a dressing forceps is shown in [Fig. 25], a toothed seizing forceps being represented in [Fig. 26].