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 hamor- 
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 hemorrhage 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 pyemia 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 
