WOUNDS. 141 



Incised Wounds are those caused by a clean cut, such as a sharp- 

 edged inBtrument. Lacerated wounds are those in which the 

 tissues are torn and the edges of the wound irregular ; punctured 

 wounds those caused by stabs or probes ; while contused wounds 

 aie those due to crushing and bruising. 



The process of healing is accomplished in different ways, 

 according to the nature of the wound, and the condition of the 

 surrounding parts. 



1. First intention — that is, by iinmediate reunion of the parts. 



2. Adhesive inflammation, in which there is an exudation of 

 lymph in both cut surfaces. 



3. Granulation, where the wound gradually heals by the formation 

 of proud flesh. 



4. The union of granulations. 



5. The commoner and more usual method of healing, under a 

 scab. 



In incised wounds the parts should be cleansed, and the bleeding 

 arrested, any hair should be removed, and the lips or edges of the 

 wound brought into immediate contact by sutures. Where practi- 

 cable, the whole should be covered with dry carboUsed tow and a 

 bandage. A muzzle must be worn, or the stitches will be torn 

 out, causing an unsightly wound that must then heal by granula- 

 tion, while instead of a very slight scar, a large one will be the 

 result. In adhesive inflammation the mode of treatment is the 

 same ; it has, however, been proved beyond doubt, that dry dressings 

 are much preferable to any other. The old method of dressing with 

 oils, etc., is no longer continued. The commonest method of 

 healing is by granulation under a scab as already noted. 



In wounds I have found the carboUsed tow and carbolised gauze 

 the most successful. The object of these is to prevent suppuration, 

 if possible, by keeping the hair aseptic. Especially is tliis the case 

 when one is trying to heal a wound by first intention, or by 

 adhesive iaflammation. In other wounds it keeps them healthy. 

 The wound must be constantly washed and kept thoroughly clean. 

 If it is a serious one, or there is much discharge, it should be dressed 

 twice a day. Where proud flesh appears, it should be kept under 

 by the application of nitrate of silver ; again if the wound is un- 

 healthy-looking, and the healing process is retarded, a slight 

 application of nitrate of silver will often stimulate it to healthier 

 growth. 



In all cases where the wounds heal by the process of granulation it 

 is absolutely necessary that the repairing process should begin at the 

 bottom, and so gradually close the wound. Should it occur at the 

 surface, the pus will be imprisoned, burrow between the muscles, and 



