WOUNDS AND INJURIES. 473 



The puncture, however, may be inflicted within structures 

 which, to lay freely open would be likely in the end to destroy 

 the patient. It may occur, for example, within a joint, or 

 amongst the tendons of a limb. It is clear, in cases of this 

 nature, such a proceeding as laying the wound freely open is 

 altogether inadmissible. The course, under these circumstances, 

 is, if possible, to carefully inspect the instrument which inflicted 

 the puncture, and from its appearance judge as to the depth it 

 may have penetrated, and whether it has left any foreign matter 

 within the injury, such as rust of iron or splinters of wood. 



In treating a punctured flexor 'tendon, we must, if possible, 

 prevent suppuration of the injured tissues. The burrowing of 

 purulent matter amongst the tendons is at all times a serious 

 affair, and to prevent it recourse must be had to many expe- 

 dients. In the first place, after having determined the extent 

 of the puncture, place upon the foot a high-heeled shoe, apply 

 a lotion of Arnica freely to the surface of the part injured, then 

 keep the limb well secured with cold water bandages, and imme- 

 diately over the seat of the injury, both upon the inner and 

 outer side of the tendons, place a small roll of wet linen, each 

 roll about three or four inches in length, and about the thick- 

 ness of the thumb. These rolls must be placed within the folds 

 of the bandage and pressed with moderate firmness to the limb ; 

 the object being, by pressure and cold, to limit the inflammatory 

 action which may ensue. If suppuration has set in before 

 medical aid was sought, the pus should be liberated, when the 

 course of treatment will still be very similar. Should matter 

 have gravitated to the fetlock, it must of course be evacuated ; 

 but the operator had better proceed with caution, lest he should 

 make an incision into the cavity of the joint. To avoid doing 

 this force the skin to one side when making the incision, so 

 that the external opening wiU not correspond to the one passing 



