WOUNDS. 



larly in hofpital praftice, where frequent change of linen is 

 not at all times obtainable, it is of great confcquencc to the 

 comfort of the patient, and to the general health and welfare 

 of the other patients, that every attention (hould be paid to 

 cleanlinefs, and that every thing filthy and offenfive ihould 

 be removed from the room or ward as quickly as poflible. 

 Above all things, care muft be taken not to let the matter 

 touch the bed-clothes. 



The frequency of drcfling muft be regulated by the 

 ■quantity and quality of the difcharge from the wound, by 

 the fituation of the injury, by the climate and feafon of the 

 year, by the effedts which the renewal of the drefiings 

 feems to produce, and by the feelings, and fometimes the 

 wi/hes of the patient. 



During the long-continued difcharge of pus from many 

 wounds, the ftrength of the patient muft be fupported, 

 and granulation and cicatrization promoted by nourifliing 

 diet and proper cordials. The moll difagreeable, and un- 

 fortunately not an unfrequent termination of large wounds, 

 is the formation of unhealthy granulations, attended with 

 a general wafting of the body and heftic fever. See 

 Thomfon's Leftures on Inflammation, p. 294, &c. 



Of punHured Wounds, or Stabs. — Punftured wounds are 

 rot only dangerous on account of their frequently extending 

 to a confiderable depth, and injuring important blood-veflels, 

 nerves, and vifcera, but they are alfo dangerous, inafmuch 

 as they often give rife to violent and extenfive degrees of 

 inflammation. It is not uncommon to fee formidable col- 

 leAions of matter follow wounds of this defcription, efpe- 

 cially when the inftrument with which they have been 

 made has penetrated any aponeurofis, or fafcia. Stabs and 

 all other punftures are not fimple divifions of the fibres of 

 the body ; they are attended with more or lefs contufion and 

 laceration, according to the particular form of the weapon, 

 and the degree of violence with which tlie thruft has been 

 made. Hence there is not the fame propenfity to union by 

 the firft intention, which we obferve in wounds made with 

 fliarp-edged inftruments ; and when ligamentous expanfions 

 are amongft the parts injured, it is not uncommon to fee 

 a train of fevere local and conftitutional fymptoms follow. 

 Immcnfe agitation of the nervous fyftem fometimes enfues 

 upon the inflidlion of a punftured wound ; and it has been 

 generally attributed to the injury of tendons or nerves. 

 This doftrine, however, is now almoft quite exploded, as 

 furgeons fo frequently fee nerves and tendons wounded, 

 without the occurrence of great conftitutional diforder. 

 The truth is, that alarming nervous fymptoms do not follow 

 punftured wounds in perhaps more than five cafes out of 

 a hundred, in which tendons and nerves of fome fize are 

 aftually injured. It cannot, therefore, be fo much the in- 

 jury of thefe parts, as other circumftances attending ttabs, 

 which are the caufe of the fevere indifpofition fometimes fud- 

 denly induced by fuch wounds. When they extend deeply, 

 the confequences of the injury of large blood-vefTels and 

 vifcera will often account for the great conftitutional dif- 

 order, without having any recourfe to doftrines like the 

 foregoing. 



Punftured wounds are frequently followed by the form- 

 ation of deeply-feated abfcefles and finufes, and hence the 

 cure is often difficult, and fometimes it cannot be effefted 

 till after a confiderable time. 



With refpeft to the treatment of punftured wounds, we 

 may obferve, that in this part of praftice erroneous fup- 

 pofitions have commonly led to many ferious abufes. The 

 unqualified idea, that the fevere confequences of moft punc- 

 tured wounds are, in a great meafure, owing to the narrow- 

 nefs of their orifices, has induced numerous furgeons to 



praftife indifcnminately deep and extenfive incifions, for 

 the purpofe of rendering their external communication con- 

 fiderably wider. To have conftantly in view the converfion 

 of fucli injuries into fimple incited wounds has always been 

 a maxim ftrongly infifted upon, and fct forth as the reafon 

 of the above method of treatment. The doftrine even 

 occafioned the frequent dilatation of punftured wounds by 

 the ftill more abfurd and cruel means, the employment of 

 tents. 



Certainly, if the notion were true, that an important punc- 

 tured wound, fuch as the ftab of a bayonet, is aftually 

 changed into a wound partaking of the mild nature of an 

 incifion, by the mere enlargement of its orifice, the cor- 

 refponding praftice would be highly commendable, however 

 painful it might be. But the faft is other^vife : the rough 

 violence done to the fibres of the body by the generality of 

 ftabs is little hkely to be fuddcnly removed by an addi- 

 tional violence — the enlargement of the wound. Nor can 

 the diftance to which a punftured wound frequently 

 penetrates, and the number and nature of the parts injured 

 by it, be at all altered by fuch a proceeding. Thefe, 

 which are the grand caufes of the coUeftions of matter 

 which often take place in the cafes under confideration, 

 muft exift, whether the mouth and canal of the wound be 

 enlarged or not. The time when incifions are proper is, 

 when there are foreign bodies to be removed, abfcefles to 

 be opened, or finufes to be divided. To make painful 

 incifions fooner than they can anfwer any end is both 

 injudicious and hurtful. They are fometimes rendered 

 quite unneceffary by the union of the wound throughout 

 its whole extent, without the leaft fuppuration. 



It is true, as is obferved in a modern publication, that 

 miking a free incifion in the early ftage of thefe cafes 

 feems a reafonable method of preventing the formation of 

 finufes, by preventing the confinement of matter ; and 

 were finufes an inevitable confequence of all punftured 

 wounds, for which no incifions are praftifed at the moment 

 of their occurrence, it would undoubtedly be unpardonable 

 to omit them. Fair, however, as this reafon for the ufe 

 of the knife may appear to fome praftitioners, it is only 

 fuperficially plaufible, and a very little refleftion foon 

 detefts its want of real folidity. Under what circum- 

 ftances do finufes form ? Do they not form only when 

 there is fome caufe exifting to prevent the healinof of an 

 abicefs i This caufe may either be the indireft way in 

 which the abfcefs communicates externally, fo that the pus 

 does not readily efcape ; or it may be the prefence of fome 

 foreign body, or dead portion of bone ; or, laftly, it may 

 be an indifpofition of the inner furface of the abfcefs to 

 form granulations arifing from its long duration, but re- 

 moveable by laying open the cavity. Thus it becomes 

 manifeft, that the occurrence of fuppuration in punftured 

 wounds is only followed by finufes, when the furgeon ne- 

 glefts to procure a free ifl"ue for the matter after its accumula- 

 tion, or when he neglefts to remove any extraneous bodies. 

 But as dilating the wound at firft can only tend to augment 

 the inflammation, and render the fuppuration more extenfive ; 

 and as likewife the new incifion may heal up by the firft 

 intention before it has anfwered any purpofe at all ; the 

 praftice fliould never be adopted in thefe cafes, except for 

 the direft objefts of giving a free exit to matter already 

 collefted, and of being able to remove extraneous bodies 

 palpably lodged in the part. We ftiall once more repeat, 

 that it is an erroneous idea to fuppofethe narrownefs of punc- 

 tured wounds fo principal a caufe of the bad fymptoms 

 with which they are often attended, that the treatment 

 ought invariably to aim at its removal. 



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