WOUNDS. 



ipon which they aft, fo as to diforder llic texture of thofe 

 Tgans which are iituated under the inleguments, without, 

 lowever, caufing any breacli of continuity in the flcin itfelf. 

 This is the cafe which is ufually called a hruife, or contujion. 

 iecondly, afting with a certain degree of violence upon the 

 ame parts, they may produce a folution of continuity which 

 5 named a contufed wound. The latter effeft more commonly 

 oUows when the furface of the contufing weapon or body 

 s not very broad. The cafes which rank as fimple bruifes 

 lave been defcribed in another volume of this publication, 

 feeCoNTUsioN, ) and therefore we ihall not detain the reader 

 vith any obfervations upon them in the prefent place. 



The majority of wounds are attended with fome degree of 

 ■ontufion. Thofe which are inflifted by the blunt edge of 

 . fabre, or by the obtufe point of a bayonet or foil, arc as 

 inuch contufed wounds as they are punftured ones ; and 

 lence, like other contufed wounds, they do not often admit 

 )f. being united by the firft intention. 

 I'l It muft be confeffed, indeed, that moft of the endeavours 

 • ;o re-unite the fides of a contufed wound, however llvilfully 

 lirefted, generally fail. An agglutination of the parts at 

 jnoft only takes place at the bottom of the wound, in which 

 ituation the fleih has fuffered lefs contufion, the violence 

 laving fpent itfelf, as it were, upon thofe parts upon which 

 t firft operated : hence fuppuration of the external por- 

 ;ion of the wound is moftly unavoidable. Still the attempt 

 (It re-miion ought to be made ; for if only the bottom of the 

 Ivound (liQuld heal by the firft intention, it will be a great ad- 

 vantage gained, more efpecially when the furface of a bone 

 ,ias been expofed and uncovered by the injury. However, 

 :.n bringing the fides of contufed wounds nearer together, the 

 turgeon is not to attempt to do it with the fame clofenefs and 

 accuracy as in the inftance of an incifed wound. The injured 

 parts would not bear the prefl'ure, and the means requifite for 

 this purpofe ; and it may be laid down as an eftabliflied rule 

 Ithat nothing is more hurtful in cafes of contufed wounds than 

 jmuch preflure, either from ftrips of adhefive plafter, or a 

 tight roller. Sutures in thefe cafes are alfo totally unjufti- 

 ifiable ; and we think we have feen feveral examples, in which 

 a ralh determination of the furgeon to clofe large contufed 

 'wounds by ftitches, tight ftrips of plafter, and bandages, 

 has had no iuconfiderable fhare in bringing on the rapid and 

 fatal gangrene which carried oft" the patients. Wiien we 

 ifay, therefore, that a contufed wound ought to be clofed, 

 'and that its oppofite fnrfaces (hould be brought nearer to 

 'each other, in order that the chance of fome part of the injury 

 .uniting by the firft intention may be taken, we do not mean 

 to recommend dragging the parts together by main force, or 

 ;placing them in a ftate of conftriftion. On the contrary, 

 'we think that they ought to be left quite unconfined, the 

 ladhelive plafter being ufed very fparingly, with confiderable 

 fpaces between the ftrips, and fo put on as rather to hold 

 I the loofe parts together than to prefs and draw them into 

 icontaft with each other. The wound then is not to be en- 

 tirely covered with fticking-plafter, a praftice which is hurt- 

 |ful even in incifed wounds, but merely a ftrip applied at par- 

 !ticular points, where the application promifes to have great 

 ;effeft in hindering the wound from gaping, without pro- 

 ducing any dangerous conftriftion of the parts. That a 

 I ftrip of adhefive plafter may frequently be ufed with ftriking 

 (advantage in contufed and lacerated wounds experience daily 

 ! proves ; and the benefit muft not furprife us, when we re- 

 I member that by preventing the wound from gaping in the 

 . manner it would otherwife do, we not only afford an oppor- 

 j tunity for parts of it to re-unite, but at once diminifti an in- 

 ; evitable caufe of inflammation and fuppuration, viz. the 

 ; expofurc of a large raw furface to the air. 



Contufed and laccr.itcd wounds not only differ from in- 

 cifed wounds in the circumftance of their being more dif- 

 pofed to fuppurate, and more difficult to heal by the firft; 

 intention, they differ alfo in the particularity of not bleed- 

 ing much, fometimes even when the largeft arteries are 

 lacerated, as muft be the cafe when whole hmbs are tora 

 away, in confequence of becoming entangled in diff^erent 

 kinds of machinery. 



This indifpofition to hemorrhage is not altogether a favom-- 

 able omen, becaufe though the patient runs lefs chance of 

 bleeding to death in thefe cafes than in cut wounds, yet the 

 very circumftance of the Large veflels not pouring out blood 

 evinces that the violence, contufion, and other injury done to 

 the parts, in addition to the mere divifion of them, muft 

 have been exceflively fevere, and that the dangers of the 

 fubfequent inflammation, fuppuration, and tloughing of the 

 parts, more than counterbalance the prefent fecurity from 

 bleeding. 



We thallnot find, in all the records of furgery, any fafts 

 more extraordinary than thofe which have been publifhed at 

 diffex-ent periods on the fubjeft of whole hmbs being torn 

 away, not only without hemorrhage, but without any other 

 fatal effefts. The cafes of limbs torn oft" related by Che- 

 felden, in the Philofophical Tranfaftions, by La Motte, in^ 

 his Traite des Accouchemens, by Mr. Carmichael, in the 

 fifth volume of the Ediub. Med. Commentaries, and others in 

 the fecond volume of the Mem. del' Acad, de Chirurgie, are 

 fome of the moil remarkable. 



As far as our obfervations extend, all lacerated and con- 

 tufed wounds fhould be treated according to common anti- 

 phlogiftic principles. When the injury is extenfive, and 

 attended with a great deal of contufion, venefeftiion is to be 

 praftifed, and the oozing of blood from the furface of the 

 wound may be encouraged by the ufe of fomentations. With 

 refpcft to dreffings, they ftiould always be of a mild un- 

 irritating quality. After lelfening, by a ftrip or two of 

 adhefive plafter, the expofed cavity of the wound, when this is 

 large and the furrounding ilcin loofe, the part may be covered 

 with pledgets of the unguentum cerx, over which fhould be 

 laid an emollient poultice. As the firft dreffings ftiould not be 

 removed for at leaft 24 or 36 hours, care ought to be taken 

 to put into the poultice a fufficient quantity of fweet oil, to 

 prevent it from becoming foon hard. Afterwards, how- 

 ever, the dreffmgs may be changed once, twice, and even 

 thrice a day, in bad cafes, with advantage ; for as foon as 

 the Houghs begin to feparate, and fuppuration to take 

 place, the neceffity for changing the dreffings and poultices 

 more frequently is felf-evident. In fevere cafes, foment- 

 ations may be ufed at the periods of dreffing ; and it will 

 be found that nothing is fo effeftual in relieving the pain 

 arifing from the inflammation which has been induced. 

 The employment of leeches alfo fliould not be forgotten, 

 as a valuable means of palliating the inflammatory fymp- 

 toms. Profeffor Afalini, of Milan, has lately written 

 ftrongly in praife of the good effefts which are produced 

 by the apphcation of cold waflies to parts which have re- 

 ceived contufed wounds (fee his Manuale di Chirurgia) ; 

 and we believe the plan is particularly ufeful in the firft in- 

 ftance, when it is a great objeft to check the increafe of 

 extravafated fluids in the furrounding parts. But after- 

 wards we think emollient applications are the beft ; anil, 

 indeed, it may be queftioned, whether the employment of 

 cold lotions at firft would not fometimes be objeftionable, in- 

 afmuch as they muft tend to flop the oozing of blood from the 

 furface of the wound ; a thing whicii is confidered by many 

 furgeons extremely beneficial, and an objeft which they 

 think ought to be promoted even by the ufe of foment- 

 ations. 



