ACCIDENTS OF ACTUAL CAUTERIZATION. 185 



an 



geon, or it may be caused by the use of too heavy or too sharp 

 instrument, or to an excess of heat or of pressure. It is recog- 

 nized by the separation of the edges of the wound, and the ap- 

 pearance at the bottom of the lines of a white nacreous stria, 

 shown by the subcutaneous tissue. There is no remedy for this 

 accident, and though it is not a very severe lesion, it is likely to 

 be followed by rough and irregular cicatrices. 



(b) Hemorrhage.— ^Q have said that firing is an essentiaUy 

 bloodless operation if properly performed. The appearance, there- 

 fore, of drops, or perhaps of a small stream of blood, at the bot- 

 tom of the lines or points, and perhaps running over the surface 

 of the skin, though unattended with danger and not likely to be 

 injurious, is, at the least, evidence of some miscarriage of skill. 

 If it arises from the use of a rough or too sharp an instrument, it 

 can be readily suppressed by searing the part, or applying upon 

 bleeding vessels another cautery, heated a little in excess of the 

 first. Sometimes the burning of a smaU quantity of pulverized 

 resin, or of a small lock of hair in the bleeding cavity, will have 

 a sufficient hemostatic effect, and simple pressure will seldom, if 

 ever, faU. 



(c) Tearing off Scabs. — This is the result of careless and in- 

 secure dressing, and in omitting to provide effective safeguards 

 for preventing the patient from reaching the wound with his own 

 teeth, or rubbing it against some hard object. Suppurating 

 wounds of various dimensions are often the result of this inad- 

 vertency, requuing careful treatment, and sometimes leaving bad 

 blemishes to be regretted. 



{d ) Sloughing of the Skin and Subcutaneous Tissues. — This 

 accident is not uncommon, and like that just mentioned, is the 

 effect of the improper application of the cautery, though less the 

 effect of the firing than of burning the parts, and it is character- 

 ized by all the conditions of ordinary burn wounds. Among 

 specific causes, howevef, may be mentioned too strong a firing, 

 or firing with lines too near together, or touching each other at 

 some angle, or in crossing, or when too large an iron is used, or 

 one brought to a radiating heat, or too high a temperature; or 

 when greasy substances have been applied in the Hnes, or the skin 

 submitted to long frictions. All these causes tend to the disorgan- 

 ization of the skin, vrith mortification and sloughing, and its separa^ 

 tion in large patches, leaving after healing, broad, ugly blemishes. 



