62 



CHAPTER V. 



Theory of Wounds and Bruises. 



CHANGES LIABLE TO TAKE PLACE IN A WOUNDED OR BEUISED TART — 

 VARIETIES OF WOITNDS — METHODS OF REPAIR — BACTERIA AND DISEASE 

 GERMS — ANTISEPTIC TREATMENT OF WOUNDS — ARREST OF 'bLEEDING. 



CHANGES LIABLE TO TAKE PLACE ]X A WOUNDED OK 

 BRUISED PART. — By the wounding or bruising of a part, the tenseness of 

 the tissues, which opposed the pressure of the blood (p. 14), becomes 

 diminished, and the parts become more or less swollen from increased transu- 

 dation of plasma. Hamilton (" Text-book of Pathology ") tells us that the 

 union of the divided .surfaces of wounds is effected always in the tame 

 manner, namely, by the growing together of the reparative material pro- 

 duced by each of the two surfaces. As these two layers of connecting 

 material cannot unite as long as they are kept apart by discharge, blood-clots, 

 or granulations ; our first efforts should be directed in checking the bleeding 

 and exudation, to do which we shall be greatly aided by pressure. " It is a 

 fact familiar to every one that a clean-cut wound made into a part tuch as 

 the finger, if kept free from organismal contamination, and if pressure be 

 immediately applied to its edge, will be found adherent in twenty-four hours, 

 and within a day or two, organic union is apparently completed " [Hamilton). 

 If, however, the exposed tis>ues become contaminated by putrefactive germs 

 (page 63) a corrosive discharge (pus, see page 15) will be established, and 

 granulations (p. 15), from absence of pressure on the walls of the capillaries, 

 will in all probability cover the divided surfaces. Our principles of treat- 

 ment should therefore be: (1) to check the discharge; (2) to prevent the 

 divided surfaces from becoming contaminated ; (3) to bring them together ; 

 and (4) to apply pressure. 



Union being impossible as long as granulations (proud flesh) exist ; the 

 reparative material which lies under thorn, has the power of destroying them 

 by the pressure it sets up on the capillaries by spontaneous contraction 

 (Hamilton). Hence we find that granulating surfaces will not unite, until 

 the granulations disappear. Hamilton regards the beneficial action of 

 caustics and stimulating lotions on granulating wounds, to be due to their 

 hastening the growth of the reparative material. 



The course of inflammation in bruises closely resembles that of sprains, 

 except that the former, on account of injury to the skin, are more liable to 

 become complicated by the formation of pus, than the latter. 



VABIETIES OF WOUNDS.— The respective characters of wounds and 

 bruises are so generally combined in injuries from external violence, that I 

 have thought it best to discuss them under the same heading. We may there- 

 fore divide them into : (1) clean cuts ; (2) punctures ; (3) lacerated wounds, 

 e.g., " broken knees " ; and (4) bruises. 



