ication of dry dressings,
with a view to avoiding the onset of moist gangrene. After granulations
have formed, skin-grafting is of value in hastening healing.

#Lightning-stroke.#--In a large proportion of cases lightning-stroke
proves instantly fatal. In non-fatal cases the patient suffers from a
profound degree of shock, and there may or may not be any external
evidence of injury. In the mildest cases red spots or wheals--closely
resembling those of urticaria--may appear on the body, but they usually
fade again in the course of twenty-four hours. Sometimes large patches
of skin are scorched or stained, the discoloured area showing an
arborescent appearance. In other cases the injured skin becomes dry and
glazed, resembling parchment. Appearances are occasionally met with
corresponding to those of a superficial burn produced by heat. The chief
difference from ordinary burns is the extreme slowness with which
healing takes place. Localised paralysis of groups of muscles, or even
of a whole limb, may follow any degree of lightning-stroke. Treatment is
mainly directed towards combating the shock, the surface-lesions being
treated on the same lines as ordinary burns.

CHAPTER XII

METHODS OF WOUND TREATMENT

Varieties of wounds--Modes of infection--Lister's work--Means taken to
prevent infection of wounds: _heat_; _chemical antiseptics_;
_disinfection of hands_; _preparation of skin of patient_;
_instruments_; _ligatures_; _dressings_--Means taken to combat
infection: _purification_; _open-wound method_.

The surgeon is called upon to treat two distinct classes of wounds: (1)
those resulting from injury or disease in which _the skin is already
broken_, or in which a communication with a mucous surface exists; and
(2) those that he himself makes _through intact skin_, no infected
mucous surface being involved.

Infection by bacteria must be assumed to have taken place in all wounds
made in any other way than by the knife of the surgeon operating through
unbroken skin. On this assumption the modern system of wound treatment
is based. Pathogenic bacteria are so widely distributed, that in the
ordinary circumstances of everyday life, no matter how trivial a wound
may be, or how short a time it may remain exposed, the access of
organisms to it is almost certain unless preventive measures are
employed.

It cannot be emphasised too strongly that rigid precautions are to be
taken to exclude fresh i