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part* U injured, symptoms of fever coma on from twenty to thirty 

 hour* after the receipt of the wuuod, which require attention on the 

 part of the surgeon, an, according to the constitution and circumstance* 

 of the patient, the fever may vary greatly, and require opposite m..<le- 

 of treatment. The fever U called symptomatic, and in most cases is 



Bamtnatory. 



Incited WatauU. The effect of a cut on any part of the body is to 

 produce a gaping space, from which blood in most cases issues, and 

 pain is felt The blood arises from the blood-vessels of the part having 

 been cut through or wounded, and the pain is caused by a similar 

 injury to the nerves. The amount of blood that issues from a wound, 

 as well as the pain, will always depend upon the nature of the part 



which is injured. Some parU of the body are very copiously supplied 

 ith blood-vessels which have few nerves, and vice rertd ; so that 



with 



neither pain nor bleeding is constant according to the size of the 

 wound. The immediate danger of incised wounds does not so much 

 arise from the extent of parts divided as upon the kind and size of the 

 blood-vessels which are injured. Thus extensive wounds may occur 

 on the back and other parts of the body without producing sufficient 

 hemorrhage to endanger life, whilst a small puncture of the jugular 

 vein or femoral artery might speedily occasion death. The integrity 

 also of some part* of the nervous system is so essential to life, that the 

 slightest wound will produce an immediate cessation of the functions 

 of the body. Thus a small puncture of some parts of the brain, cere- 

 bellum, and spinal cord will cause immediate death. The remote con- 

 sequences of wounds also vary in some measure with the kind of tissues 

 and the organs wounded. Wounds situated near moving parts some- 

 tunes never heal. Wounds of tendinous and ligamentous structures 

 do not heal so rapidly as those of muscular and other tissues ; and 

 thus it is that wounds of the joints are frequently healed with great 

 difficulty. 



The amount of gaping of a wound depends on the kind of tissues cut 

 through. The skin is elastic ; and thus, whenever it is cut through, 

 the wound gapes by reason of its elasticity. Where there is much 

 cellular tissue the wound does not gape so much, as this tissue is not 

 elastic. Wounds of muscles differ : if the cut is in the direction of 

 their fibres, then the wound gapes but little ; but if it be across the 

 fibres, then, owing to their contractile nature, the wound gapes very 

 considerably. Wounds may be also made to gape or to close their 

 edges, according to the state of flexion or extension of the muscles 

 under the part in which they are situated. 



The vessels injured in incised wounds are either artcrirt or ve'au, and 

 each require attention from 'the surgeon, as the bleeding from them 

 requires somewhat different treatment. When an artery is wounded, 

 there is an immediate retraction of the ends of its middle and internal 

 coats within the outer or investing coat, and also a contraction of all 

 the coats so as to diminish the calibre of the artery. Blood flows from 

 both ends of a divided artery, but always in greater quantity from the 

 orifice nearest the heart. The blood from an artery can easily be dis- 

 tinguished by its bright red colour and by its coming out in jerks. 

 When a cut artery is left to itself, the effusion of blood is great, but 

 the flow becomes less and less profuse, and in passing over the rough- 

 ened surface of the external sheath, from which the two inner coats 

 have been separated by retraction, particles of the blood adhere to its 

 loosened filaments. These particles keep increasing in number, till at 

 last the whole space between the end of the external sheath and the 

 ends of the two retracted coats is filled up, the blood having fonncil 

 there a firm coagulated mass. When this process is completed, the 

 bleeding from the artery stops. This mass of coagulated blood is 

 called the external coagulum, but the same process is carried on within 

 the retracted inner coats of the divided artery, and the coagulum is 

 continued up to the point at which the artery gives off one of its 

 branches. This coagulum terminates with a conical extremity in the 

 middle of the tube of the artery, and is called the internal <' 

 The blood also which is effused outside the artery altogether coagulates, 

 and to some extent may assist in the natural process of arresting the 

 haemorrhage. But these coagula of blood would not be sufficient alone 

 to restrain the haemorrhage ; another process follows, which perma- 

 nently effects this. This consists in the effusion of lymph from the 

 parietes of the artery itself. This lymph fills up the entire extremity 

 of the artery, and is first deposited between the external and internal 

 coagula, but it goes on increasing till at last it occupies their position, 

 the coagula are absorbed, and the lymph, becoming eventually organised 

 by the development within its substance of blood-vessels, forms a part, 

 as it were, of the artery iUelf , and connects it more or less with the 

 surrounding part*. 



When an artery is only partially divided or punctured, a somewhat 

 different process takes place. Blood is effused between the artery and 

 its sheath, both above and below the wounded part. In consequence 

 of this the artery i* distended, and a difference in the relative positions 

 of the internal coats and the sheath takes place, and the blood coagu- 

 lating is confined by the sheath over the wounded part of the internal 

 coats. Lymph is effused as in the former case, and the cure is only 

 effected by the obliteration of the artery. 



When the veins are wounded, tut blood which is poured out is of a 

 dark colour, and comes not by jerks, but in a uniform stream. There 

 is not so much danger from the bleeding of a vein as an artery, and it 

 is much more easily stopped. When a vein U cut through, the oppo- 



site ends are closed by blood and the subsequent organisation of lymph. 

 as in arteries. If only slightly punctured, and Longitudinally, 

 quickly heal, as is seen in the common operation of veiuw. 

 veins are wounded obliquely or transversely, tin- w..mnl i* clow 

 coagulum of blood, add the lips of tin- wound i-wr.-tr lymph. 

 eventually becomes organised, aud blocks up tin- -..!. 

 ally the coagulum thus formed is absorbed. This reparative process 

 is much longer in taking place than that which occurs in arteries undi i- 

 the same circumstances. 



,nrnt. In the treatment of incised wounds the objects in \ i< v.- 

 are, first, to arrest the haemorrhage; secondly, t. , remove all t 

 bodies that may have been introduced into the wound; and, tl, 

 to promote the union of the divided parts. 



The arrest of bleeding is easily accomplished by bringing the edge* 

 of the wound together, in superficial wounds, and wounds where no 

 large arterial or venous trunks have been injured ; but where large 

 vessels have been injured, other means will be found necessary. > 

 is nothing perhaps which distinguishes modern surgery more than tlir 

 power which it has attained of arresting hscmorrhage. The sin 

 through his knowledge of the circulation and the means of an 

 mechanically the flow of blood, can venture upon cutting through all 

 but the principal trunks of the arterial and venous system. \VI. 

 bleeding from a wound is great, the first thing that can be <1 

 arrest it is to eomprea the trunk of the artery which up]>l 

 This may be done by means of the tourniquet [Tornxnji n], or a 

 bandage so constructed as to press down upon the artery. Tli< 

 lation of the blood in the arterial trunk being arrested, the hemorrhage 

 from the wound will in a great measure cease. Compression h 

 can seldom be used for a sufficient length of time to act as a curative 

 agent in stopping the flow of blood. In the first place, alii 

 pressure by bandage may stop the supply of blood through the principal 

 arterial trunk, it will not stop it through deeper-seated br.i 

 by arresting the return of the blood by the veins, it may, mm, -r . 

 circumstances, tend to increase the bleeding. Even when . ircum- 

 stances are most favourable, the tourniquet and bandages are likely to 

 get displaced, and thus to suffer the return of the bleeding. 



The most important of the means of stopping bleeding from wounds 

 is the l!<i(iturr. This consists in seizing the wounded ends of the 

 with a pair of forceps, or passing through it a teutaculuin, ami then 

 tying up the artery in the same way that the mouth of .1 full sack is 

 usually tied. For this operation all the skill that is required is ana- 

 tomical knowledge. Care should be taken, whilst the necessary instru- 

 ments are Wing prepared, that the bleeding is prevented by pressure 

 on the trunk of the artery, or by placing the finger over the 1<I 

 orifice itself. The forceps which are mostly used on this occa*:- 

 the common dissecting forceps, but Mr. Liston recommends a ] 

 forceps with hooks at their points, and which, after having grasped the 

 artery, are kept together by means of a button or hook. " When no 

 assistant is at hand, and in cases of emergency, the surgeon provided 

 with this little instrument, can tie vessels without the least difficulty ; 

 and iu oi>erations, when many vessels spring, several of these forceps 

 can be applied : there is, besides, this great advantage in their em- 

 ployment, that a clumsy assistant can scarcely include the point of the 

 instrument with the vessel." (Liston.) The immediate effect of a 

 tightly-drawn ligature is to arrest the flow of blood, to divide the 

 middle and internal coats of the artery at the ligatured part (the exter- 

 nal sheath remaining entire), and to narrow the canal for some extent 

 above the ligature. The same process of cure goes on then as when 

 the artery heals spontaneously. 



Other means of arresting haemorrhage are sometimes employed, such 

 as tli.- application of styptics [ASTKIXUEXTS], sponge, the actual cautery, 

 caustics, &c. These, however, are seldom advisable in the case of in- 

 cised wounds. There is, however, a popular prejudice in favour of 

 applying various styptics to cuts for the purpose of stopping the 

 bleeding, and it cannot be too generally known that all these applica- 

 tions are injurious, and tend to retard the cure ; and that in some 

 instances loss of life is the consequence of these applications to wounds 

 that would have got well had they been left to themselves. [H.&MO- 

 niuiAiiK; ARTERY; HEART.] 



The second indication in the treatment of incised wounds is the 

 removal of foreign bodies. Unless all extraneous substances are 

 removed from a wound, its union will not be effected, and suppu . 

 abscesses, and perhaps sloughing, will occur. It is in gun i 

 that this indication requires the greatest attention, but f. 

 are occasionally introduced into incised wounds. [OI-N.-IIOT \\ '< 

 Wounds from broken china, glass, and earthenware frequently have 

 fragments of these substances in them. Sharp instruments are fre- 

 quently coveted with dirt and various impurities ; hence the import- 

 ance of cleaning even incised wounds. John Hunter advocat 

 leaving blood on the edges of the wound, as he supposed it was the 

 blood that became organised and united the wound ; but this is now 

 found to be erroneous, and all surgeons advocate the practice of 

 removing as much of the blood as possible from the wound. 



The third indication in the treatment of incised wounds is to l.ring 

 the edges of the wound together, and to retain them so in such a man- 

 ner as shall favour their speedy union. Wounds may unite in two 

 ways either by the establishment of an inflammation, the result of 

 which u the secretion of pus, and the formation of what are called 



