WOUNDS. 



remark ; for it fometimes happens that breaches of con- 

 tinuity, botli in the foft and hard parts, are caufed by the 

 violent aftion of the mufcles. Thus, the patella and os 

 brachii are occafionally fraftured by the powerful contrac- 

 tion of the mufcles ; and the mufcles either tear themfelves 

 afunder, or rupture the tendons with which they are con- 

 nefted. Sometimes, alfo, the (harp point of a broken bone 

 wounds the fuperincumbent integuments, and changes the 

 cafe into a compound fradlure. Here we fee the caufe is 

 mechanical, but yet not of an external kind, as in ordinary 

 1 examples. 



' Wounds are divided by the writers on furgery into 

 feveral kinds, the diftinftions being founded either upon the 

 fort of weapon with which the injury was inflifted ; or 

 upon the circumftance of a venomous matter having been 

 inferted into the part ; or, lallly, upon the particular fitu- 

 lation of the wound, and the nature of the wounded parts 

 themfelves. Hence we have cuts, incifwm, or inc'ifed mounds, 

 which are fuch as are produced by (harp-edged inltrnmcnts, 

 and are generally free from all contufion and laceration. 

 The (ibres and texture of the wounded part have fuffered 

 no other injury but their mere divifion ; and there is confe- 

 iquently lels tendency to inflammation, fuppuration, gas- 

 grene, and other bad confequences, than in the generality 

 of other fpecies of wounds. Incifed wounds alfo may 

 ufually be healed with greater quicknefs and facility than 

 iother wounds, which are accompanied with more or lefs con- 

 itufion and laceration : the furgeon has only to prevent the 

 ]folution of continuity from gaping, or, in other words, he 

 ;has fimply to brnig the oppofite fides of the wound into 

 icontaft with each other, and keep them in this (late a few 

 jhours, and they will unite and grow together. 



Another clafs of wounds Tive Jiabs, or punflured wounds, 

 made by the thruft of pointed weapons, like bayonets, 

 lances, fwords, daggers, &c. and alfo by the accidental 

 and forcible introduftion of confiderable thorns, large nails, 

 l&c. into the fle(h. Thefe wounds frequently penetrate to 

 a great depth, fo as to injure large blood- vefTels, vifcera, 

 land other organs of importance ; and as they are generally 

 linflifted with much force and violence, the parts fuffer more 

 'injury than what would refult from their fimple divillon. It 

 'alio deferves notice, that a great number of the weapons, 

 or inftruments, by which punftured wounds are occafioned, 

 increafe materially in diameter from the point towards their 

 jother extremity ; and hence, when they penetrate far, they 

 !muft force the (ibres afunder like a wedge, and caufe a 

 ferious degree of ftretching and contufion. It is on this 

 laccount that bayonet wounds of the ordinary foft parts are 

 .'very often followed by violent inflammation, an alarming 

 [degree of tumefaftion, large abfcefles, fever, delirium, and 

 'other very unfavourable fymptoms. The opening which 

 jthe point of fuch a weapon makes is quite inadequate for 

 ,the paffage of the thicker part of it, which can only enter 

 |by forcibly dilating, llretching, and otherwife injuring the 

 Ifibres of the wounded fle(h. 



A third defcription of wounds are the conlufed and 

 ^lacerated, which ftriftly comprehend, together with a va- 

 jriety of cafes produced by the violent application of hard, 

 Iblunt, obtufe bodies to the foft parts, all thofe interefting 

 'and common injuries denominated gun-Jhot tuuunds. Many 

 ibites rank alfo as contufed and lacerated wounds. In (Iiort, 

 [every folntion of continuity, which is fuddenly produced in 

 Ithe foft parts by a blunt inllrument, or weapon which has 

 jneithcr a (harp point nor edge, muft. be a contufed, lacerated 

 .wound. 



I Poifoned wounds are thofe which are complicated with the 

 lintroduftion of a venomous matter, or fluid, into the part. 

 I VojL. XXXVIII. 



Thus the flings and bites of a variety of infeds a(Tord us 

 examples of poifoned wounds ; but a more ferious and dan- 

 gerous inftance, which we meet with in this chmate, is feen 

 in the cuts accidentally received in the dilfeftion of putrid 

 bodies, or in handling inftruments infefted with any irritating 

 venomous matter ; as fometimes happens to the furgeon in 

 the performance of operations on gangrenous limbs, and in 

 the application of drefTmgs to venereal and other infeftious 

 ulcers. The mod dangerous, however, of all the poifoned 

 wounds, which ever occur in this kingdom, are thofe re- 

 fulting from the bite of the viper, and from the bites of 

 rabid animals, particularly the dog and cat. See Hydro- 

 phobia. 



Wounds are farther divided by furgical writers into 

 wounds of the head, wounds of the face, wounds of the throat, 

 wounis of the chefl or thorax, wounds of the belly or abdomen, 

 wounds of the limbs or extremities, wounds of the arteriesy 

 •wounds of the veins, &c. &c. 



Wounds may hkewife be univerfally referred to two other 

 general claffes, vix. fimple and complicated. A wound is 

 cMed Jimple, when it occurs in a healthy fubjeft ; has been 

 produced by a clean, (harp-edged inftrument ; is unattended 

 with any ferious fymptoms ; and the only indication is to 

 re-unite the frcfli-cut furfaces. A wound, on the contrary, 

 is faid to be complicated, whenever the (late of the whole 

 fyftem, or of the wounded part, or wound itfelf, is fuch as 

 to make it neceffary for the furgeon to deviate from the 

 plan of treatment requilite for a common fimple wound. 

 The differences of complicated wounds muft, therefore, be 

 very numerous, as they depend upon many incidental cir- 

 cumftances, the principal of which, however, are, hemor- 

 rhage, nervous fymptoms, contufion, the unfavourable (hape 

 of the injury, the difcharge or extravafation of certain fluids 

 indicating the injury of particular bowels or veifels, the pre- 

 fence of foreign bodies or of a virus in the part, lofs of 

 fubftance, the attack of hofpital gangrene, &c. See 

 Ulcer. 



All large or deep wounds are attended vifitli more or lefs 

 fymptomatic fever. It ufually comes on, as Dr. Thomfon 

 obferves, at a period varying from fixteen to thirty-fix 

 hours after the infliftion of the injury. Its occurrence is 

 indicated by an increafed warmth of the (kin ; by increafe 

 in the frequency, and generally alfo in the ftrength of the 

 aftion of the heart and arteries ; by anxiety, thirft, and by 

 the fuppreffion of the powers of digeftion. The fymp- 

 tomatic fever from wounds is generally of the inflammatory 

 charafter ; and it even fometimes happens that a very high 

 degree of fymptomatic fever occurs in debilitated conftitu- 

 tions, and in perfons who have loft a confiderable quantity 

 of blood. In thefe cafes, the frequency of the pulfe, how- 

 ever, is more remarkable than its ftrength, and the fever 

 which occurs feems to refemble more an afthenic fever than 

 it does one that is truly inflammatory. It is of great con- 

 fequence to attend to the type of this fever in the treatment ; 

 for the lofs of blood, which may be required and fuftained 

 with impunity in the one fpecies of fever, may prove molt 

 injurious, if not fatal, in the other. Thomfon's Letlures, 

 &c. p. 292. 



We fliall now proceed to offer a general defcription of the 

 feveral kinds of wounds, and the manner of treating them; 

 and then notice the wounds of particular parts, and the fur- 

 gical meafures which feem beft calculated to promote their 

 cure. As, however, wounds of the head, comprehending 

 its external coverings, and the cranium and brain, form the 

 fubjefts of articles already publiihed, thefe cafes will not 

 fall under confideration in the fubfequent columns, the 

 reader being referred for information concerning them to 



4 Y COWPRESSIOX, 



