es should be
used sparingly, if at all.

The best way in which to treat such wounds is by the _open method_. This
consists in packing the wound with iodoform or bismuth gauze, which is
left in position as long as it adheres to the raw surface. The packing
may be renewed at intervals until the wound is filled by granulations;
or, in the course of a few days when it becomes evident that the
infection has been overcome, _secondary_ sutures may be introduced and
the edges drawn together, provision being made at the ends for further
packing or for drainage-tubes.

If earth or street dirt has entered the wound, the surface may with
advantage be painted over with pure carbolic acid, as virulent
organisms, such as those of tetanus or spreading gangrene, are liable to
be present. Prophylactic injection of tetanus antitoxin may be
indicated.

CHAPTER XIII

CONSTITUTIONAL EFFECTS OF INJURIES

SYNCOPE--SHOCK--COLLAPSE--FAT EMBOLISM--TRAUMATIC ASPHYXIA--DELIRIUM
IN SURGICAL PATIENTS: _Delirium in general_; _Delirium tremens_;
_Traumatic delirium_.

SYNCOPE, SHOCK, AND COLLAPSE

Syncope, shock, and collapse are clinical conditions which, although
depending on different causes, bear a superficial resemblance to one
another.

#Syncope or Fainting.#--Syncope is the result of a suddenly produced
anaemia of the brain from temporary weakening or arrest of the heart's
action. In surgical practice, this condition is usually observed in
nervous persons who have been subjected to pain, as in the reduction of
a dislocation or the incision of a whitlow; or in those who have rapidly
lost a considerable quantity of blood. It may also follow the sudden
withdrawal of fluid from a large cavity, as in tapping an abdomen for
ascites, or withdrawing fluid from the pleural cavity. Syncope sometimes
occurs also during the administration of a general anaesthetic,
especially if there is a tendency to sickness and the patient is not
completely under. During an operation the onset of syncope is often
recognised by the cessation of oozing from the divided vessels before
the general symptoms become manifest.

_Clinical Features._--When a person is about to faint he feels giddy,
has surging sounds in his ears, and haziness of vision; he yawns,
becomes pale and sick, and a free flow of saliva takes place into the
mouth. The pupils dilate; the pulse becomes small and almost
imperceptible; the respirations shallow and hurried; conscio