WOUNDS. 



From what has been ftated, it feems then that in wounds 

 of parts deftitute of contractile properties, as the flcin, cel- 

 lular membrane, ligaments, fafcise, &c. their elafticity is 

 |the only caufe of fuch wounds gaping, or of the feparation 

 which happens between the oppofite furfaces of the injury ; 

 but that in mufcular wounds the feparation is theeffeft both 

 of the contraclile and elaftic powers of the part. Hence, 

 ias we have already obferved, the feparation is greater the 

 [more tenfe the mufcle is at the inftant when the wound is 

 infliaed. 



I " The edges of every incifed wound ( fays profeflbr Thom- 

 ■fon) are more or lefs retradled, or drawn from each other, 

 iand this generally in proportion to the fize of the wound, 

 land the nature of the parts upon which it is inflifted. The 

 (different foft textures of which the human body is com- 

 pofed are more or lefs elaftic, and are in the healthy condi- 

 ' tion of the body kept in a certain degree of tenfion. When 

 the fibres, therefore, of any of thefe textures are divided, 

 • they recede from each other; thofe of flcin farther than 

 ■ thofe of cellular membrane, and thofc of mufcle farther 

 than thofe of flcin. The fibres of mufcle contraft mod of 

 I all. The extremities of a divided artery recede confiderably 

 ! from each other ; the veins lefs than the arteries, and the 

 i nerves probably lefs than the veins. To oppofe this con- 

 ! traftion of divided parts by fuitable means, is one of the 

 ' main objefts which the furgeon propofes to himfelf in the 

 1 cure of wounds ; for the retradlion of the edges of wounds 

 ', from each other always prevents re-union by the firfl inten- 

 1 tion, and very often retards it for a long time by the fecond." 

 ; See Thomfon's Ledlures on Inflammation, p. 280 ;] alfo 

 I Union by the Firjl Intention. 



; The prognofisof wounds made with a cutting inftrument 

 varies according to the extent and depth of the divifion, the 

 nature of the injured parts, and the circumftances which at- 

 , tend the accident. Deep large wounds are more dangerous 

 and more difficult to cure than thofe which only intereft. the 

 ! flcin. Wounds, accompanied with injury of confiderable 

 I veflTels or nerves, are more or lefs dangerous, according to 

 the magnitude or number of thofe veffels or nerves. Simple 

 v.-ounds, in which the only indication is to bring the divided 

 jiarts together, fo that they may re-unite, are the mod favour- 

 jihle cafes of all. On the other hapd, complicated wounds 

 ?ae more or lefs hazardous, according to the particular 

 nature of the complication. In the prognofis of wounds 

 alfo, we mud not forget to take into confideration the pa- 

 tient's age, his kind of conftitution, and the difeafes under 

 v.liich he may labour. Generally fpeaking, the mod dan- 

 -\'rous examples of incifed wounds are thofe which are made 

 about the throat by perfons who attempt to deftroy themfelves. 

 Here there are fo many large blood-veffels, nerves, and 

 other parts of great importance, that deep incifed wounds 

 too often prove fatal, either immediately, or in the courfe 

 of a few days. Sometimes the patient opens the carotid 

 artery, and perifhes of hemorrhage on the fpot, before any 

 afTidance can be rendered. In other inilances, he divides fome 

 ' )f the principal branches of the external carotid, and after 

 loling a great deal of blood he faints, and the hemorrhage 

 fpontaneoudy ceafes for a time. The fainting indeed is often 

 ihe very thing which faves his life, by checking the effufion 

 of blood until a furgeon arrives, who ties the veffeis as foon 

 as they begin to bleed again. Cut wounds of the extremi- 

 ties, when fuch arteries as the femoral and brachial are in- 

 jured, may alfo fuddenly deftroy the patient, by the great 

 quantity of blood which is fometimes loft before the arrival 

 of furgical afliftance. 



A furgeon, called to a recent cut or incifed wound, has 



three objefts which he fhould endeavour to accomplifh with. 

 out the lead delay. 



The firft, and that which requires his immediate inter- 

 ference, is the bleeding, which mud be checked, or the 

 patient may lofe his life in a few minutes. 



The fecond is the removal of all extraneous matter, 

 foreign bodies, &c. from the cavity of the wound. 



The third is to bring the oppofite fuifaces of the wound 

 into even contaft, and to adopt proper meafuresfor keeping 

 them in this pofition, Uintil they have grovi'n together 

 again. 



I. Hemorrhage — For an explanation of the means which 

 nature employs in the fuppreffion of bleeding from divided 

 arteries, as well as for an account of the beft chirurgical mea- 

 fures for promoting this objeft, and a detail of numerous 

 obfervations on the principles by which the conduft of the 

 furgeon fhould be regulated in the ufe of the ligature, we 

 beg to refer to the articles Hemorrhage and Ligature. 



In the prefent place we (hall briefly notice how the fur- 

 geon ought to aft in cafes of incifed wounds, accompanied 

 with hemorrhage, without pafliiig over, however, a few 

 things which have been fuggefted fince the above-mentioned 

 articles were written. 



It has been dated, that in every wound the bleeding is the 

 thing which demands the earlieft attention ; becaufeif lofsof 

 blood be not prevented without delay, the patient will fre- 

 quently die in the courfe of a few feconds, or minutes. 

 Every other confideration may be deferred ; but when large 

 velfels are injured, they mud be immediately fecured, or elfe 

 the fudden death of the patient will leave the furgeon no 

 opportunity of exhibiting his flcill and ufefulnefs in other 

 matters connefted wi'h the treatment. 



It is not, however, every bleeding which is thus ferious 

 and alarming ; for the flighteft and mod fuperficial cuts are 

 always attended with fome effufion of blood. When the 

 divided veffels are of inferior fize, the bleeding foon fponta- 

 neoufly ceafes, and no furgical meafures need be taken on 

 this particular account. When the wounded vedels are eveu 

 fomewhat larger, and their fituation is favourable for com- 

 preflion with a bandage, it is often advifeable to clofe the 

 wound, and apply a comprefs and roller, indead of having 

 recourfe to hgatures, which always produce irritation, fup- 

 puration, and an obdacle to the union of that part of the 

 wound in which they lie. Yet, let the furgeon, before he 

 determines to trud to preffure, be well affured, that the 

 bleeding can be thus perfeftly and fafely commanded without 

 the employment of ligatures ; for by the failure of cora- 

 prefiion, hemorrhage has often been renewed from time to 

 time, and many a life been loft. We therefore wiili it to be 

 diftinftly underttood, that in almoft all cafes of confiderable 

 bleeding, the patient will not be fafe unlefs the velfels be 

 tied, and that the only exceptions are a few inftances 

 in which the bleeding arteries can be effeftually com- 

 preffed againil a fubjacent bone, and are not of very large 

 fize. In all other examples, tying the bleeding veffels is 

 the only fafe mode of proceeding. When the artery is of 

 large diameter, and its mouth can be readily feen, the moft 

 proper inftrument for taking hold of it is a pair of arterial 

 forceps. With this inftrument, the end of the veffel is to be 

 drawn out a little way from the furrounding flefli, in order 

 that a ligature may be put round it without the inclufion of 

 any other parts, which would be unneceffary, painful, and 

 on feveral accounts difadvantageous. In applying the liga- 

 ture, the furgeon muft take care to pull its two ends in fuch 

 a manner that the noofe will not rife above the mouth of the 

 veffel ; and, for the purpofe of altering the direftion of the 

 4 Y 2 force 



