62 



CHAPTER V. 



Theory of Wounds and BRaiSES. 



CHANGES LIABLE TO TAKE PLACE IN A WOUNDED OB BRUISED PART 



VARIETIES OF WOUNDS METHODS OF REPAIR BACTERIA AND 



DISEASE GERMS ANTISEPTIC TREATMENT OF WOUNDS ARREST OF 



BLEEDING. 



CHANGES LIABLE TO TAKE PLACE IN A WOUNDED OB 

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

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

 diminished and the parts become more or less swollen from inoieased 

 transudation of plasma. The union of the divided surfaces of wounds is 

 effected always in the same manner, namely, by the growing together of 

 the reparative material produced by each of the two surfaces. As these 

 two layers of connecting material cannot unite as long as they are kept 

 apart by discharge, the 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 such 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. If, however, the exposed 

 tissues 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 pro- 

 bability cover the divided surfaces. Our principles of treatment 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 them, has the power of destroying 

 them by the pressure it sets up in the capillaries by spontaneous con- 

 traction. 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. 



VARIETIES 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 

 therefore divide them into : (1) clean cuts ; (2) punctures ; (3) lacerated 

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



