INCISED WOUNDS. 449 



haemorrhage; 2. To remove foreign "bodies; 3. To effect and 

 maintain co-adaptation; and 4. To guard against excessive 

 inflammation. (1.) Haemorrhage, whether arterial or venous, 

 is to be arrested, and this is the first thing that must be attended 

 to. If it arises from a small artery partially cut, blood of a 

 bright red colour flows or spurts out in jets ; but if it be com- 

 pletely cut across, the ends contract, and the haemorrhage ceases. 

 In some cases the bleeding will continue although the artery be 

 divided completely across, or will take place from time to time, 

 and prove serious. In such instances the end of the artery must 

 be searched for, drawn out by the forceps, and tied by a ligature ; 

 occasionally it will be found necessary to enlarge the wound to 

 do this effectually. 



Venous bleeding is generally easily arrested by moderate 

 pressure, or by an astringent application, such as a solution of 

 the tincture of terchloride of iron. As a rule, even these slight 

 applications are unnecessary, venous bleeding stopping spon- 

 taneously if the wound is exposed to cold air ; but if a large 

 vein be wounded, it is often necessary to tie it with a ligature. 



When the bleeding is arrested, all clots of blood, dirt, and 

 foreign bodies are to be removed from the wound by careful 

 sponging with tepid water. In sponging a wound, care must 

 be taken not to injure its surface by any undue pressure. It 

 is quite sufficient to squeeze the water out of the sponge on to 

 the wound, without the sponge being brought into contact with 

 it. This is easily done by placing the sponge at a little dis- 

 tance above the wound, and allowing the water to flow gently 

 over the wounded surface. If any materials are firmly im- 

 bedded in the tissues, they must be removed by the forceps or 

 the point of the finger. Cleaning wounds with a coarse brush 

 cannot be too highly condemned. 



In wounds where muscular fibres are deeply cut, it is recom- 

 mended, more especially by Mr. Syme, that the wound should 

 remain open for about eight hours, for the purpose of allowing 

 the discharges of blood and serum to escape ; or if sutures are 

 immediately employed, they should be applied in such a loose 

 manner as to allow the blood and serosity to escape, and all 

 clots which may afterwards form washed out. This is good 

 practice, and ensures healing by adhesion in many cases that 

 would otherwise run on to the more tardy process of granulation. 

 2a 



