can then be withdrawn in the manner indicated in figure 4-32D. Animal Bites A special kind of infection that must be guarded against in case of animal bites is rabies (sometimes called “hydrophobia”). This disease is caused by a virus that is present in the saliva of infected animals. The disease occurs most commonly in wild animals, but it has been found in domestic animals and household pets. In fact, it is probable that all mammals are susceptible to it. The virus that causes rabies is ordinarily transmitted by a bite, but it can be transmitted by the saliva of an infected animal coming in contact with a fresh wound or with the thin mucous membrane of the lips or nose. The virus does not penetrate normal unbroken skin. If the skin is broken, DO NOT attempt wound closure. If rabies develops in man, it is usually fatal. A preventive treatment is available and it is very effective, but only if it is started shortly after the bite. This treatment is outlined in BUMEDINST 6220.6. Since the vaccine can be obtained only at a medical treatment facility or a major ship, any person bitten by an animal must be transferred quickly to the nearest treatment facility for evaluation, along with a complete report of the circumstances surrounding the incident. Remember, prevention is of utmost importance. Immediate local treatment of the wound should be given. Wash the wound and the surrounding area carefully, using sterile gauze, soap, and sterile water. Use sterile gauze to dry the wound, and then cover the wound with a sterile dressing. DO NOT use any chemical disinfectant. Do not attempt to cauterize the wound in any way. All of the animal’s saliva must be removed from the victim’s skin to prevent further contamination of the wound. CAUTION: DO NOT allow the animal’s saliva to come in contact with open sores or cuts on your hands. When a person has been bitten by an animal, every effort must be made to catch the animal and to keep it confined for a minimum of 8 to 10 days. DO NOT kill it if there is any possible chance of catching it alive. The symptoms of rabies are not always present in the animal at the time the bite occurs, but the saliva may nevertheless contain the rabies virus. It is essential, therefore, that the animal is kept under observation until a diagnosis can be made. The rabies treatment is given if the animal develops any definite symptoms, if it dies during the observation period, or if for any reason the animal cannot be kept under observation. Remember that any animal bite is dangerous and MUST be evaluated at a treatment facility. WOUND CLOSURE LEARNING OBJECTIVE: Recognize the different types of suture material and their uses; recall topical, local infiltration and nerve-block anesthetic administration procedures; and identify the steps in wound suturing and suture removal. The care of the wound is largely controlled by the tactical situation, facilities available, and the length of time before proper medical care may be available. Normally, the advice to the Corpsman regarding the suturing of wounds is DO NOT ATTEMPT IT. However, if days are expected to elapse before the patient can be seen by a surgeon, the Corpsman should know how to use the various suture procedures and materials, and how to select the most appropriate of both. Before discussing the methods of coaptation (bringing together), some of the contraindications to wound closing should be described.  If there is reddening and edema of the wound margins, infection manifested by the discharge of pus, and persistent fever or toxemia, DO NOT CLOSE THE WOUND. If these signs are minimal, the wound should be allowed to “clean up.” The process may be hastened by warm, moist dressings, and irrigations with sterile saline. These aid in the liquefaction of necrotic wound materials and the removal of thick exudates and dead tissues.  If the wound is a puncture wound, a large gaping wound of the soft tissue, or an animal bite, leave it unsutured. Even under the care of a surgeon, it is the rule not to close wounds of this nature until after the fourth day. This is called “delayed primary closure” and is performed upon the indication of a healthy appearance of the wound. Healthy muscle tissue that is viable is evident by its color, consistency, blood supply, and contractibility. Muscle that is dead or dying is comparatively dark and mushy; it does not 4-41