WOUNDS. 



ations. This is a point, however, which comparative and 

 unprejudiced experience is alone capable, of deciding. If, in 

 cafes of lacerated and contufed wounds, the furgeon is lefs 

 frequently, than in incifed wounds, called upon to take 

 meafurcs for flopping bleeding immediately after the acci- 

 dent, he finds greater occafioii for attending to another im- 

 portant duty, impofed upon him in his profefTional attend- 

 ance upon wounded perfons in general : we allude to the 

 early removal of all foreign bodies and extraneous fub- 

 ftances from the wound. Cuts are ufually made with 

 clean fharp inftruments ; but contufed and lacerated 

 wounds often occur in a manner which renders them par- 

 ticularly likely to contain dirt, gravel, bits of glafs, porce- 

 lain &c. We have feen one cafe in which the patient 

 could not ufe his arm for a twelvemonth, in confequence of 

 fome fragments of a broken bottle not having been taken 

 out of a wound of the hand in the firfl; inftance. The 

 wound did indeed heal up ; but the pieces of glafs oc- 

 cafioned fo much pain and inconvenience, that the part 

 could not be ufed. New incifions were unfuccefsfully 

 made for their removal, and the fingers were becoming per- 

 manently bent and contrafted when we laft faw the patient. 

 Whether the foreign bodies have been fubfequently ex- 

 trafted we know not ; but the cafe deeply imprefled us 

 with the importance of always removing extraneous fub- 

 fiances while a wound is frefh, and bell admits of the requi- 

 fite examination. 



With regard to lacerated wounds, the fame praAical 

 remarks apply to them which have been offered on the fub- 

 jeft of contufed wounds ; but the prognofis is generally 

 confidered as more unfavourable, and in warm cUmates 

 tetanus is alleged to be a very frequent confequence of 

 thefe injuries. See Tetanus. 



The bites of rabid animals afford examples of a mofl 

 dangerous defcription of lacerated and contufed wounds, the 

 peril, however, originating not from the mechanical injury 

 itfelf, but from the cafe being complicated with the infer- 

 tion intp the wounded part of a poifon or virus, the effefts 

 of which, when they do occur, almofl bid defiance to the 

 power of the medical art. See Hydrophobia. 



As foon as the furface of a contufed or lacerated wound 

 has thrown off its floughs, fuppurated, became clean, and 

 evinced a tendency to form granulations, the poultices are 

 to be difcontinued, and fimple dreffings employed. Thefe 

 are afterwards to have their quality altered, according to 

 the appearances which the fore may afTume ; but any fur- 

 ther direftions refpefting the management of the cafe, after 

 it has arrived at this flage, mufl be quite fu peril uous 

 here, as ample inflruftions will be found in the article 

 Ulcer. 



Some contufed and lacerated wounds would inevitably 

 be followed by the rapid mortification of the limb, and the 

 patient run the greatefl rifle of lofing his life, were amputa- 

 tion not to be performed immediately after the receipt of 

 the injury. Thefe are generally examples in which the 

 foft parts are extenfively and deeply wounded, and large 

 blood-veffels and nerves alfo injured. The fize, however, 

 of the wound feems of itfelf fometimes to be a caufe of 

 gangrene ; for we remember a brewer's fervant, who, when 

 fitting on the fore-part of a dray-cart, met with an injury, 

 by which the fliin covering the front of the tibia was torn 

 from the knee to the ankle, and though no other mifchief 

 appeared to have been received, the whole limb and even the 

 fcrotum rapidly mortified, and the man loH his life. It 

 fhould be known, that thefe are cafes of what M. Larrey 

 calls traumatic gangrene, in which he and fome other 

 modern furgeons conceive that amputation may often be 



done with fuccefs, though the mortification has not ceafed to | 

 fpread at the time of the operation. (See Surgery.) 

 This praftice had alfo its advocates in former days ; but ' 

 fince the time of Mr. S. Sharp and Mr. Pott, the rule of ! 

 never attempting amputation before a line of feparation has ! 

 formed between the dead and living parts, has been acknow- ' 

 ledged, taught, and refpefted, in every fchool of furgery. I 

 For an account of the treatment of contufed and lacerated ' 

 wounds which have ended in mortification, the reader mufl 

 turn to the article Gangrene. 



Of Gun-Jhot IVounds Striftly thefe cafes ought, per- 

 haps, to be clafTed with other wounds, attended with much . 

 contufion and laceration of the parts ; but the injuries i 

 which are received in modern warfare from the employment ■ 

 of fire-arms are fo numerous, complicated, and various, ; 

 that the fubjeft undoubtedly merits feparate confideration. ' 

 A general defcription of thefe accidents, and of the method j 

 of treatment, will be found under the head of Gun-shot 

 Wounds. Since that article was written, however, fo much ', 

 valuable information has been laid before the public by ' 

 feveral diftinguifhed army and navy furgeons, that it be- j 

 comes neceffary for us to avail ourfelves of the prefent op- | 

 portunity to notice fome praftical points of the firfl-rate '; 

 importance in military furgery. I 



Amongft the obfervations on the fubjeft of Gun-Jhot ' 

 IVounds in a former volume, the reader will find a flatement 

 of fome of the fentiments which were entertained by the 

 late Mr. Hunter concerning the treatment of thefe injuries. ' 

 It will there be found, that this celebrated furgeon, as well 

 as a few other eminent praftitioners, was far from being an 

 advocate for immediate amputation, even in cafes in which 

 he acknowledged that there was no poffibility of ultimately 

 faving the injured limb. It was his opinion, that more pa- 

 tients died when the operation was done early, than when • 

 it was performed in a later flage, after inflammation had 

 fubfided, and fuppuration had been fairly eftabhfhed. 

 Such precepts, however, do not coincide with the refults of | 

 modern experience ; and, as in numerous inftances, the deci- ' 

 fion for amputation or for delay involves the queflion of 

 life or death, we think that every opportunity ought to be 

 taken of refuting this part of Mr. Hunter's writings. 



According to the united obfervations of all well-informed 

 experienced army furgeons, it may now be fet down as an 

 eflablifhed rule in military furgery, that in every cafe in 

 which a limb is fo Jhattered and injured, that no probability of 

 its being finally faved prefents itfelf, amputation ought to be done 

 at once, 'without any delay. For nearly the lall two hundred 

 years, there have always been fome men of talents and expe- 

 rience, who not only recommended, but aftually adopted 

 this judicious praftice. Du Chefne, who wrote in 1625, 

 advifes the performance of amputation in cafes of fevere 

 injuries of the limbs ; and it is worthy of remark, that he 

 direSs the operation to be performed before inflammation and 

 other conjlitutional fymptoms ha-vefupervened, ( See Traite de 

 la Cure generale et particuhere des Arcbufades, Paris, 1 625, 

 p. 143.) Wifeman, the father of Englifh furgery, not 

 only recommended and praftifed immediate amputation, 

 but the fame thing was not unfrequently done by the mih- 

 tary furgeons of his time. (Chirurgical Treatifes by R. 

 Wifeman, 3d edit. London, 1696, p. 410. ) The cele- 

 brated Le Dran, in his excellent little manual of military 

 furgery, declared himfelf an advocate for immediate amputa- 

 tion in all cafes in which that operation from the firft ap- 

 pears to be indifpenfable. ( See Traite ou Reflexions tirees 

 de la Pratique fur les Plaies d'Armes "a feu, Paris, 1737.) 

 Ranby, who was ferjcant-furgeon to king George II., en- 

 tertained opinions fimilar to thofe of Le Dran, with regard 



to 



