ck, and urgent operations are
performed, such as amputation for gangrene, tracheotomy for dyspnoea, or
laparotomy for perforated or lacerated intestine. In the majority of
cases the main object is to guard against infection; the skin is
disinfected over a wide area and surrounded with towels; damaged tissue,
especially muscle, is removed with the knife or scissors, and foreign
bodies are extracted. Torn blood vessels, and, if possible, nerves and
tendons are repaired. The wound is then partly closed, provision being
made for free drainage, or some special method of irrigation, such as
that of Carrel, is adopted. Sometimes the wound is treated with bismuth,
iodoform, and paraffin paste (B.I.P.P.) and sutured.

4. _In the Base Hospital or Hospital Ship_ various measures may be
called for according to the progress of the wound and the condition of
the patient.

#Shell Wounds and Wounds produced by Explosions.#--It is convenient to
consider together the effects of the bursting of shells fired from heavy
ordnance and those resulting in the course of blasting operations from
the discharge of dynamite or other explosives, or from the bursting of
steam boilers or pipes, the breaking of machinery, and similar accidents
met with in civil practice.

Wounds inflicted by shell fragments and shrapnel bullets tend to be
extensive in area, and show great contusion, laceration, and destruction
of the tissues. The missiles frequently lodge and carry portions of the
clothing and, it may be, articles from the man's pocket, with them.
Shell wounds are attended with a considerable degree of shock. On
account of the wide area of contusion which surrounds the actual wound
produced by shell fragments, amputation, when called for, should be
performed some distance above the torn tissues, as there is considerable
risk of sloughing of the flaps.

Wounds produced by dynamite explosions and the bursting of boilers have
the same general characters as shell wounds. Fragments of stone, coal,
or metal may lodge in the tissues, and favour the occurrence of
infective complications.

All such injuries are to be treated on the general principles governing
contused and lacerated wounds.

EMBEDDED FOREIGN BODIES

In the course of many operations foreign substances are introduced into
the tissues and intentionally left there, for example, suture and
ligature materials, steel or aluminium plates, silver wire or ivory pegs
used to secure the fixation