WOUNDS. 25 



culation and sensibility, taking care that it be not excessive^ which 

 would lead to dangerous inflammation. First rub the part with 

 snow, and then with cold water in a room without fire. For the 

 comatose condition of the body produced by cold, also use friction 

 with snow, in a cold room, afterwards substituting fur or flannel ; 

 gradually giving warm and stimulating drink, such as wine and water. 



BURNS AND SCALDS, 



There are three principal divisions of these injuries, which may be 

 produced by hot fluids, vapour, flame, or solids. 



1st. Those which produce mere redness and slight inflammation, 

 terminating in resolution, and perhaps desquamation. 



2d. Those causing vesications of the cuticle, which often dry up 

 and heal ; but if the cutis has been injured and inflamed, suppura- 

 tion and ulceration result. 



3d. Those causing the death of the part, in which there is not 

 much pain, and which are followed by sloughs. 



Extensive burns, even if superficial, are very dangerous ; and 

 those upon the trunk are more fatal than those of the extremities. 

 The symptoms are paleness and shivering, with a feeble, quick pulse; 

 often prostration, coma, and death. The greatest danger is during 

 the first four or five days, from collapse; subsequently from an 

 affection of head, chest, or abdomen, or from prostration. 



Treatment. — Bathing the part in cold water will mitigate the heat, 

 pain, and inflammation ; afterwards it must be protected from the air 

 by cotton, or some bland unctuous substance, care being taken to dis- 

 charge the vesicles without removing the cuticle. Calm the nervous 

 excitement with opium, and prevent sinking with wine and ammonia. 

 Be careful of over stimulation, and promote the separation of sloughs 

 by rest, poultices, and fomentations. Regulate the diet, and encourage 

 granulations by water dressings, saturated with salts of copper, zinc, 

 or silver, or with chloride of lime. Contraction of cicatrices is to 

 be prevented by mechanical means, and the function of joints is to 

 be retained by passive motion. 



WOUNDS. 



Wounds are classified into incised, contused, lacerated, punctured, 

 poisoned, and gunshot. 



Incised. — 'I'hese are produced by sharp-edged instruments, and 

 bleed freely. They heal in various ways ; hy adhesion^ or union 

 hif the first intention^ in which there is no suppuration. Fibrin is 

 thrown out, and coagulating, becomes organized, and constitutes a 

 new living structure ; incorporated with the cut surfaces, it restores 

 the solution of continuity in the solid parts. 



Wounds heal by growth, whereby reparation is made, without 

 inflammation and suppuration, as in ordinary nutrition. 



