WOUNDS. 27 



granulation. At first it will be necessary to arrest hemorrhage, re- 

 move foreign bodies, bring the parts in apposition by strips of ad- 

 hesive plaster, and apply water-dressings, or a light poultice, accord- 

 ing to the condition of the patient. Cold and other antiphlogistic 

 means, such as bleeding and purging, must be used cautiously when 

 there has been a great shock upon the system, otherwise the vitality 

 of the parts will be depressed, and the risk of gangrene increased ; 

 but after fever and suppuration are established, the usual means of 

 combating inflammation may be employed. When the sloughs are 

 numerous, and the discharge profuse, typhoid symptoms will appear, 

 especially if the patient be much reduced by depletion and rigid diet. 



Punctured and Penetrating. — These are inflicted by sharp- 

 pointed instruments, and are extremely dangerous, on account of the 

 injury done to important parts, by opening vessels and cavities, and 

 from the diffusion of purulent secretions, and the liability of tetanus. 



Treatment. — After ascertaining that the wound contains no foreign 

 matter, apposition is effected, and maintained by position, rest, and 

 dressings, and the system placed under antiphlogistic regimen ; 

 adhesion is to be expected, or reparation by granulation. There 

 may be severe secondary symptoms arising from secondary hemor- 

 rhage, or confined purulent secretions ; it may be necessary to ap- 

 ply a ligature upon the artery above the ulcerated wound ; or, to 

 open and dilate it for the exit of pus, or a foreign body before un- 

 discovered. 



Poisoned. — These include bites and stings of animajs, and the 

 effects of dissecting wounds. 



The stings of ordinary insects are not sufficiently severe to 

 require surgical aid, unless in great number, and in peculiar situa- 

 tions. Children sometimes sufl^er with fever and headache, when 

 stung in a number of places ; and the suffocation produced by a 

 sting in the pharynx is alarming. 



Treatme7iL — For the common sting of a wasp or bee, remove the 

 sting of the animal with forceps, should it remain, and apply some 

 stimulating application, such as turpentine, cologne water, or harts- 

 horn. Hartshorn will probably give most relief, especially com- 

 bined with cold applications. If there is faintness or depression, ad- 

 minister wine and opium. If the sting is in the fauces, use leeches 

 internally and externally, stimulating gargles, and, if necessary, open 

 the trachea. 



Spiders^ especially the tarantula, scorpions^ and serpents, inflict a 

 most severe injury. The bite of the viper, cobra cle capello, and 

 ratHesnake, is attended with great pain, swelling, constitutional dis- 

 turbance, and death. In such wounds great caution must be used to 

 extract the poison from the wound, arid to prevent its passing into 

 the circulation. Surrounding the limb with a ligature, bathing the 



