FLESH WOUNDS. 367 



again the parts cannot be brought into perfect apposition. Healing by 

 direct union is therefore out of the question. Under favorable circum- 

 stances \ve may perhaps obtain the conditions necessary for healing a 

 portion of the wound by adhesion. Usually however these wounds re- 

 quire to be healed by the more tedious process of granulation. 



Lacerated wounds seldom bleed much, even though some of the arteries 

 may be divided, because the vessels are torn, and in consequence contract 

 and retract within their sheaths ; and again, the torn filaments favour 

 the formation of an external clot by entangling small particles of the 

 fibrin of the blood. 



The parts must be brought as nearly as possible into apposition. From 

 the nature of the wound it is not probable that the edges can be made to 

 meet. It is seldom advisable to cut off any portion of the skin, even 

 though it may be detached. Isolated pieces of skin, which may be left 

 in parts, should be permitted to remain. They may become points of 

 connection, and so reduce the size of the cicatrix. True skin, it must be 

 remembered, is never reproduced. 



If violent inflammation sets in, fomentations and poultices must be 

 applied to reduce it. If this unfavorable symptom is not present, the 

 wound can be treated as recommended in paragraph 754. If the wound 

 subsequently becomes unhealthy or indolent, or if excessive granulations 

 appear, the measures recommended above for such cases must be resorted 

 to. Sutures are seldom of much use or even available in these cases. A 

 depending orifice must be secured. The wound must be frequently 

 cleansed, and the carbolic spray as recommended for open joint may be 

 used with advantage. 



In those cases, where from pain and irritation traumatic fever sets in, 

 sedatives and a mild dose of physic will probably be needed. As a pre- 

 ventive, it is always advisable to lower the diet of the patient for a few 

 days after the occurrence of the injury. Afterwards a liberal diet is 

 essential, or the powers of nature will not be able to carry on the process 

 of repair. The chief danger to be apprehended in Lacerated wounds is 

 the occurrence of tetanus, or lockjaw. (For Lockjaw see Chap. 33.) 



756. Treatment of Contused Wounds. 



By Contused Wounds are meant injuries inflicted by bruising the skin 

 and subcutaneous tissues without any absolute breach of the skin. Such 

 wounds generally contain serum, or a mixture of blood and serum under 

 the skin. In the progress of any serious contused wound there are two 

 distinct periods, namely the separation of the slough produced by the 

 contusion, and that of the repair of the chasm by granulations. If the 

 parts around are much bruised, superficial slough may ensue to a consider- 

 able extent. Before healthy granulations can form, the wound must 

 discharge itself of all dead matter. Minor contused wounds do not 

 generally run to sloughing. 



The great principle in the treatment of contused wounds is to render 

 them of a simple character by giving to the confined matter and extrava- 

 sated blood a free exit by making an incision at the lowest part. All 



