ACCIDENTS AND OPERATIONS. 357 



together with sutures, and so maintained as long as possible, 

 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 cauterized. 



Punctured wounds are generally very troublesome ; they 

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

 sible to tell to what extent they go, or what foreign matters 

 may be left behind ; thocns, for instance, or the rust off a 

 spike or nail, may, from remaining unextracfed, 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 

 around it should be cut off, so that it may not become matted 

 and form an obstruction to the discharge of pus ; this will 

 also facilitate the daily examination and treatment of the 

 wound. If the puncture be in the foot, and there is reason 

 to suppose a thorn or rusty nail has produced it, a poultice is 

 advisable, and the insertion occasionally of a little caustic. 

 It should never be allowed to heal unless the attendant is 

 satisfied it is sound at the bottom ; otherwise, as before ob- 

 served, deep-seated abscess and sinuses will result. 



When the opening is small, pus has accumulated, and the 

 swelling above extensive, it is better to enlarge the wound 

 with a scalpel, or lance, and inject it with warm water. 



Contused wounds are best treated by poulticing and fo- 

 mentation ; if only slight. Nature herself will effect a cure. 



Sloughing, more or less, may be expected if the wound is 

 more than superficial.. When the injury extends to the 

 deeper-seated structures, and there is much extravasation of 

 blood, scarifying and repeated fomentations are indicated. 

 When the crushing has been so great that the textures under- 

 neath the muscles and bloodvessels are ruptured, extensive 

 sloughing is sure to follow. Healing in such a case takes 

 place by granulation, and the reparation needed being gener- 



