Accidents and Operations. 387 



twofold effect follows its use, viz., a destruction of the 

 present flesh, that which it comes in contact with, and a 

 stimulus to growth of the future tissue. Sluggish wounds, 

 therefore, that are occasionally treated with caustic, granu- 

 late much more rapidly than under any other treatment. 



In healing by granulation care should always be taken 

 that the wound heals from the bottom, otherwise the con- 

 fined pus will burrow, and deep-seated abscess or sinuses 

 be the result. This is particularly to be observed in punc- 

 tured wounds. 



Lacerated wounds must of necessity heal by granulation. 

 In the first instance, the wound should be cleansed from 

 clots and any foreign matters. If there is excessive haemor- 

 rhage, it will be necessary to secure the vessel, if possible, 

 by ligature, or pack the wound with a portion of sponge or 

 tow, saturated with some astringent — as solution of alum 

 or tincture of iron. 



This may be removed in twenty-four hours, and if no 

 secondary haemorrhage occurs, the stimulating liniment 

 before advised may be injected, and the same treatment 

 followed as is given in wounds healing by granulation. 



When no skin is removed, the edges should be brought 

 together with sutures, and so maintained as long as pos- 

 sible, taking care to leave a free passage for the discharge 

 of pus. If the sutures are tied in bows, they can be readily 

 unfastened for the withdrawal of the packing and reclosed. 



Lacerated wounds from bites should be freely cauterised. 



Punctured wounds are generally very troublesome ; they 

 may be called deceptive wounds, for sometimes it is im- 

 possible to tell to what extent they go, or what foreign 

 matters may be left behind ; thorns, for instance, or the 

 rust off a spike or nail, may, from remaining unextracted, 

 produce pyaemia and death. Such wounds, then, should 

 always be carefully examined, and the probe is only a safe 

 explorer in the hands of a professional man. 



As the orifice is frequently exceedingly small, the hair 

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