26 * SURGERY. 



Wounds heal by the modelling process, which is somewhat simi- 

 lar to the last, the gap gradually filling up with lymph, and restor- 

 ing the deficiency. 



Wounds heal by granulation, constituting union by the second 

 intention, a process formerly described in treating of abscess. 



Treatment. — This consists in arresting hemorrhage, removing 

 foreign bodies, bringing ihe edges together, and promot^g adhesion. 



Hemorrhage is arrested by cold applications, elevated position, and 

 compression, or, if an artery has been cut, by a ligature, or by torsion. 



Ligatures are usually made of silk or thread, and should be round 

 or twisted, in order to divide the internal and middle coats of the 

 artery. Animal ligatures are sometimes used on account of their 

 speedy decomposition, and separation from the artery ; ligatures of 

 lead have also been used. 



Compression can be effected by the tourniquet, bandages, and pled- 

 gets of lint ; in lieu of a tourniquet a Spanish windlass may be used, 

 which is made by tying a handkerchief around a limb, and twisting 

 it tightly with a stick. 



Styptics are also used where the vessels are small, and the actual 

 cautery when the hemorrhage cannot be arrested by other means. 

 Foreign bodies, such as pieces of glass, clots of blood, &c., &c., are 

 to be removed from the wound, and the lips brought together by 

 means of adhesive plaster applied to surfaces cleanly shaved, and 

 free from moisture. 



Sutures, or stitches, are to be used only when the edges cannot 

 be approximated by other means. An interrupted suture is made 

 by passing a needle, armed with a single ligature, through both lips 

 of the wound, which are then to be drawn together without any 

 great straining, and secured by a double knot. These stitches are 

 to be made at intervals of about an inch, but should not be made in 

 any tendinous structure, or highly inflamed part. 



A twisted suture is made by transfixing the margins of the wound 

 with a needle or pin, and passing around it a wax ligature in the 

 form of the figure 8, by which means the edges are brought in con- 

 tact ; the point of the pin, or needle, is to be protected with wax, 

 and allowed to* remain for several days. 



The continued, or glover suture, is nothing more than the ordinary 

 mode of sewing cloth or leather. 



Contused AND- Lacerated. — These resemble each other; are 

 attended with little hemorrhage, because the arteries are little torn, 

 and do not bleed so much as when cut. They are dangerous, be- 

 cause they are liable to inflammation and sloughing, and are often 

 complicated with foreign bodies ; and they are more apt to produce 

 constitutional disturbance and tetanus. 



Treatment. — Adhesion is impossible ; suppuration must take place, 

 and the dead parts be thrown oflT; the reparation takes place by 



