WOUNDS. 



Recent puuftured wounds have abfurdly had the fame 

 plan of treatment applied to them as old and callous fiftuls. 

 Setons and ftimulating injeftions, which in the latter cafe 

 fometimes aft beneficially, by exciting fuch inflammation as 

 isproduftive of the effufion of coagulating lymph, and of 

 the granulating procefs, can never prove ferviceable when the 

 indication is to moderate an inflammation which is difpofed 

 to rife too high. The counter-opening, which mufl: be formed 

 in adopting the ufe of the feton, is alfo an objedion ; and 

 though French authors have given us accounts of their 

 having drawn their fetons acrofs patients' chefts, in cafes ot 

 ftabs, they will find fome difficulty in making the praftice 

 feem unattended with harm, much lefs produftive of good. 

 The candid and judicious furgical reader ftiould not always 

 think a plan of treatment right becaufe the patient gets well ; 

 for there is an eflential difference between a cure promoted 

 by really ufeful means and an efcape, notwithftanding the 

 employment of hurtful ones. 



For our own part, we cannot fee what good can ever pof- 

 fibly arife from the ufe of fetons in cafes of punctured 

 wounds. Will a feton promote the difcharge of foreign 

 bodies, if any happen to be prcfent ? By occupying the 

 external openings of the wound, will it not be more likely 

 to prevent it ? In fad, will it not itfelf aft with all the in- 

 conveniences and irritation of an extraneous fubftaiice in the 

 wound ? Befides, let it be recollefted, that punftured 

 wounds are rarely accompanied with the lodgment of foreign 

 bodies. Is a feton a likely means of diminifliing the immo- 

 derate pain, fwelling, and extenfive fuppuration fo often 

 attending punftured wounds ? It will undoubtedly prevent 

 the external openings from healing too foon ; but cannot 

 this objeft be effefted in a better way ? In mod inftances 

 where much matter is collected, and where the fuppuration 

 is likely to laft a long while, in confequence of exfoliations, 

 there will be no chance of the finus heahng up prematurely ; 

 and if fuch riflf fliould appear probable, it is always eafy to 

 maintain an external opening by the daily introduftion of a 

 probe into the finus, and a fmall doflil of lint into its orifice. 

 See Firfl; Lines of Surgery, edit. 3. chap. xvi. 



When a furgeon is called to a punftured wound or ftab, 

 he may often form fome opinion refpefting the depth and na- 

 ture of the injury by examining the weapon with which it 

 was done, and obferving how far the blood reaches along the 

 blade from the point, and by attending to the quantity and 

 quality of the fluids which may ilfue from the external open- 

 ing. Thus, the efcape of chyle or feces will denote that the 

 bowels are injured ; the effufion of urine will indicate that 

 the bladder or fome part of the urinary organs is wounded ; 

 and the flow of much arterial blood will prove that a confi- 

 derable artery is opened. Wounds of the lungs will alfo 

 be attended with particular fymptoms, as we fhall notice in 

 fpeaking of wounds of the chefl:. In many inftances, how- 

 ever, important vifcera and large deep-feated arteries are in- 

 jured by ftabs, and yet no information can at firft be de- 

 duced refpefting what has happened from attention to local 

 fymptoms alone. The faintnefs and great fudden proftra- 

 tion of ftrength, the faultering. low, and intermitting 

 pulfe, the vomiting or coughing up of blood, and the 

 eoldnefs of the extremities, however, are ftill fufficient evi- 

 dence that the cafe is complicated with injury of important 

 organs, and that the patient is in a ftate of urgent danger. 

 Thefe are matters which will be beft underftood when we 

 come to the confideration of wounds of the cheft and belly, 

 and therefore we (hall not dwell upon them at prefent. 



From what has been already ftated, the reader muft be 

 aware that we do not follow the bulk of furgical writers in 

 recommending the indifcriminate dilatation of the orifices of 



punftured wounds ; nor do we admit the propriety of ufing 

 the knife for the purpofe of preventing mifchief only ex- 

 pefted and apprehended, but not aftually exifting. When- 

 ever we have had an opportunity of attending bayonet or other 

 punftured wounds, unattended with any particular compli- 

 cation, we have always obferved nearly the fame principles 

 as are now fo generally approved of in cafes of gun-fliot 

 wounds. We have abftained from dilating the orifice of the 

 injury, except when it was neceflary either to get at a bleed- 

 ing artery in the firft inftance, or to give a freer egrefs to the 

 difcharge in a later ftage of the cafe. We have given the pre- 

 ference to mild, fimple, unirritating, and fuperficial dreffings. 

 We have not placed much faith in the utihty of enveloping 

 the parts in a tight bandage ; but, after applying the firft 

 fuperficial dreffings, have ufually covered the limb with linen, 

 wet with the lotio plumbi acetatis, or cold water. When- 

 ever a roller was ufed, it was not with a view of making 

 preflure, but of retaining the dreffings. The wound having 

 been drefled, we have then ufually put in praftice all fuch 

 means as are generally deemed moft efficient in preventing 

 and diminifhing inflammation ; fuch as venefeftion, the exhi- 

 bition of aperient and fahne medicines, low diet, &c. When 

 the pain was very fevere in the beginning, we have prefcribed 

 opiates, and on the accefs of much fwelling, have always 

 been careful to let the bandage be flack. We believe that, 

 on the whole, the apphcation of fuperficial dreffings and 

 cold waflies is moftly the beft praftice for the firft twenty- 

 four hours after the receipt of a punftured wound. But if 

 after this period the pain fliouId appear to incr>-afe, and the 

 fwelling to become more and more confiderable, the furgeon 

 may then remove the bandages, and apply from fix to a 

 dozen leeches to the neighbourhood of the wound. He 

 muft alfo fubftitute for the cold lotion the ufe of foment- 

 ations, and emollient poultices, under which is to be laid 

 over the orifice of the wound a fmall pledget of fpermaceti 

 cerate, or other fimple ointment. The poultices and fo- 

 mentations are to be renewed morning and evening, and tlie 

 leeches may be repeated, if neceflary, three or four times. 



By purfuing this antiphlogiftic fort of treatment, fuppu- 

 ration may be fometimes entirely prevented, and the form- 

 ation of large deep abfceffes frequently averted. Should ex- 

 tenfive colleftions of matter, however, take place, proper 

 openings are to be then made without delay, either by di- 

 lating the original wound, or by making one or more inci- 

 fions in other places, as may feem moft advantageous. The 

 cafe, in faft, is then to be treated upon the very fame prin- 

 ciples which are obferved in the management of abfcefles in 

 general. 



Of contufed and lacerated Wounds. — The inftruir.ents which 

 have the eff^eft of producing what is termed a eontufion, are 

 either of an ordinary defcription, fuch as a cudgel, a ftone, 

 &c. or they confift of balls, bullets, and other metallic bodies, 

 which are impelled into the flefli with immenfe velocity by 

 theexplofion of gunpowder. The latter occafion particular 

 kinds of injury, well known by the name oi gun-Jhot ivounds, 

 which are a clafs of cafes fo highly interefting, that although 

 they are ftriftly only examples of feverely contufed wounds, 

 furgeons have always found it expedient to treat of them as 

 dittinft and pecuhar cafes. Indeed, when it is recoUefted 

 how many difficult, intricate, and momentous queftions the 

 fubjeft of gun-(hot wounds embraces, the neceffity of con- 

 fidering it by itfelf is immediately manifeft. 



The blunt weapons, or obtufe hard fubftances, which, 

 being applied with violence to any part of the living body, 

 bruife, rupture, and other ivife hurt the fibres and veflTels, 

 may produce two different fpecies of injury. Firft, they 

 may more or lefs forcibly comprefs and crufti the parts 



upon 



