CHIRURGERY. 427 



the blood is flowing. When an artery is completely divided, the ends 

 contract spontaneously into the cellular tissue, and the coagulated 

 blood may prevent farther bleeding ; but with the risk of ulceration. 

 Hence, a badly wounded artery should if possible be taken up on both 

 sides, and secured by ligatures, that the wound may heal. A great 

 object, in these cases, is to avoid inflammation ; or, if produced, to 

 allay it, by bleeding, and laxatives ; or to bring it to a healing suppu- 

 ration. Should gangrene, or mortification ensue, as when the wounded 

 arteries fail to nourish the limb, the last resort is amputation, or the 

 cutting off of the part affected. 



Wounds, are either incised wounds, inflicted by a sharp cutting 

 instrument, without injury to the surrounding parts ; or contused 

 wounds, as punctures, lacerations and gunshot wounds, in which the 

 surrounding parts are bruised and injured. The dressing of wounds, 

 requires that the blood should be stanched, and the large arteries 

 secured ; after which, the wound is washed, the sides approximated, 

 and held together, by narrow strips of adhesive plaster, with openings 

 between ; or, if necessary, by more powerful bandages, or sutures. 

 When the wound is slight, and the parts heal immediately, they are 

 said to unite by the first intent: otherwise suppuration follows, 

 with a discharge of pus, or fluid matter. Contused wounds, or 

 bruises, and especially punctured wounds, or stabs, are often more 

 dangerous than cuts ; as the bruised and deadened parts must be 

 removed by suppuration, before the wound can heal. The applica- 

 tion of a poultice ; the allaying of inflammation, by reduced diet, and 

 blood-letting if necessary ; and entire rest and composure, with opi- 

 ates, if required, to allay extreme pain ; are among the best remedial 

 measures. 



In case of the dislocation of a limb, the bone should be restored to its 

 place ; and in the case of a fracture, the broken parts require to be 

 carefully readjusted to each other, and kept in their position by proper 

 fixtures and bandages. A thorough knowledge of Anatomy, is of 

 course requisite, to detect fractures or dislocations, and readjust the 

 parts ; which, in some cases, requires the application of powerful 

 forces. When the skull is fractured, the broken parts are frequently 

 forced inward, and exert a pressure on the brain ; which must be 

 relieved as speedily as possible, or the insensibility which it produces 

 will soon result in death. The last resort in this case, and in other 

 cases of like pressure, is trepanning, or cutting a circular piece out 

 of the skull. The instrument employed, is a cylindrical saw, turning 

 like an auger, but with teeth set around one end of it : and it is called 

 a trepan, or trephine. This operation should generally be followed 

 by blood-letting ; to diminish the subsequent inflammation of the 

 brain. 



2. Under the head of Normal Surgery, we would treat of those 

 operations which are necessary to promote recovery from ordinary 

 diseases ; or to remedy malformations ; excepting diseases or mal- 

 formations of the eye, the ear, and the teeth, which are reserved for 

 the following section. The word normal, from the Latin norma, a 

 rule, is here used in reference to the regular action of the organs, or 

 the proper shape and state of the parts, on which it is intended to act. 



