SUBCUTANEOUS WOUNDS. 149 
They are very obstinate wounds to cure, generally resist all the 
numerous remedies recommended : emollients, narcotics, astringents, 
vesications, light caustics, cold affusions or continued irrigation. They 
can only be healed by excision of the granulations and fungosities with 
the bistoury, or by destroying them with energetic caustics, such as the 
red-hot iron. 
If the wound is superficial and spreading, the granulating surface 
should be excised. Often, however, they are implanted so deeply that 
the curette must be used in addition to the bistoury to remove them 
completely. With the curette it is easy to clean the walls of the cavi- 
ties where the layer of morbid tissue presents sometimes considerable 
thickness. When the wound is once cleaned, it is covered with a dress- 
ing, or treated with frequent applications of antiseptic vaseline. 
When actual cauterization is used, all the morbid tissue must be de- 
stroyed with cauteries in point, heated to sherry red or white heat and 
pushed into the deepest layer of the diseased part. If the punctures 
thus made with the cautery are very close, the entire granulating sur- 
face is transformed into one eschar, which suppuration soon eliminates. 
After cauterization, it is advantageous to have recourse to continued 
irrigation. 
There are granular wounds which, during the warm season, resist the 
abrasions of the granulating layer, and cauterization. They go back to 
their former condition and last until the end of fall or even until late in 
winter. 
In meridional countries, some of these wounds are seen to assume an 
ulcerous character, gradually spreading in width and depth, without 
being any better during the cold season. When they have resisted 
several successive operations, it is better to destroy the patient, if it is 
vf little value, than to continue a treatment doubtful as to its results. 
IX. 
SUBCUTANEOUS WOUNDS. 
Whether from accident or from an operation, subcutaneous wounds 
of like dimensions are much less serious than exposed wounds. The 
traumatic center has a temporary continuity with the outside through 
a small solution of continuity, but this soon becomes obliterated; the 
tissues are then protected against infectious agents, and if the wound- 
ing body has not infected them, ‘cicatrization takes place rapidly, as 
with protected wounds. The inflammatory phenomena are slight, 
diminish after a few days and soon disappear; and since the skin is 
divided only for a short distance, the pain is moderate. Struck with 
the benignity of accidental subcutaneous wounds and the rapidity of 
