WOUNDS. 



<Jo every itiiiig in our power to avert inflammation. The two 

 firft objefts cannot be fulfilled without keeping the eye-lids 

 continually clofed. The prompt re-union of the wound is 

 one of the molt effectual means of preventing inflammation ; 

 but when this aifeclion cannot be entirely hindered, it is to 

 be refilled by the kind of treatment which is explained in 

 the article Ophthalmy. 



Wounds made with pointed inftruments may pafs through 

 the eye-lids into the orbit, and thence through the thin 

 bones which compofe this cavity into the brain ; or the 

 weapon may penetrate direftly between the eye-ball and fide 

 sf the orbit into the brain. Injuries of this defcription ge- 

 nerally prove fatal on the fpot, though fometimes the patient 

 lingers for a few hours. 



In many inftances, an injury by a ball, inflifted in the 

 neighbourhood of one eye, produces paralyfis of the other. 

 " Pierre RoufTUlier, of the 25th regiment of the line, in the 

 fervice of Napoleon, (fays Mr. Hennen,) was wounded on 

 the 1 8th of June, at Waterloo. The ball entered the right 

 ;ye ; the left, though not in the flighteft degree injured to 

 ippearance, was completely blind. Rare, however, are the 

 :afes where death does not follow all wounds, particularly 

 fmall punftured ones, going direftly forward into the orbit, 

 as this did. I felt under the zygoma, and all along the 

 neighbourhood of this poor fellow's wound ; but in the 

 puffy (tate of the parts could not deleft the courfe of the 

 ball. He himfelf was confident it had gone into his brain. 

 He returned to France convalefcent. Garengeot (Traite 

 des Operations, vol. iii. obf. 20.) gives us an interefting 

 cafe from the lefturesof Petit, in which a foldier received a 

 wound towards the great angle of the eye. It was deemed 

 but of little confequence, and healed under the common 

 hofpital treatment. The man expreffed a wifh to leave the 

 liofpital, although cautioned by the furgcon, and had fcarcely 

 reached the door when he was feized with rigors, obliged to 

 return, and died in two days. On diffeftion, the ball was 

 found lodged under the fphenoid cells and the hole of the 

 optic nerve. The effeft on this man's fight is not men- 

 tioned." Hennen's Obf. on Military Surgery, p. 360. 



Wounds of the lower part of the forehead, or eye-brow, 

 arc fometimes followed by the diforder named piofis, in which 

 the upper eye-lid hangs down more or lefs over the eye ; but 

 more commonly they give rife to an oppofite complaint, 

 called lagophthalmus, in which, from a contraftion of the 

 cicatrix, the Ikin is drawn up, and the upper eye-lid cannot 

 be made to cover the eye. See ihofe terms. 



Wounds of the eye-brows fometimes caufe a fpecies of 

 blindnefs named the gutta ferena. This confequence is 

 commonly thought to be owing to an injury of the nervous 

 filament, which comes out of the orbit at the notch in the 

 fuperciliary ridge. It is very probable, however, that the 

 affeftion of the eye is not altogether dependent on the 

 injury of the nerve ; for the blindnefs very often occurs when 

 the cut is not fituated near the track of the nerve, and fre- 

 quently does not occur when the nerve is known to be 

 wounded. According to Richter, it is when the wound is 

 nearly or quite healed that the event is moft likely to 

 happen. 



Scarpa has fet dow-n the gutta ferena, arifing from an in- 

 jury of the fupra-orbitary nerve, as abfolutely incurable ; 

 but we know that this Itatement is not altogether corrtft ; 

 for Mr. Hey has recorded in the Med. Obf. and Inquiries, 

 vol. v. an example of amaurofis which got well, though it 

 originated from a wound of the eye-brow. See Gutta 

 Serena. 



Mr.Hennen fays, he has met with one or two cafes of amau- 

 rofis from wounds of the fupra-orbitary nerve. The per- 



feft divifion of the nerve did no good ; but after fome lime 

 the eye partially recovered. On Military Surgery, p. 366. 



Wounds of the eye-lids fcarcely admit of an effeftual ap- 

 plication of adhefive plaller, and their edges are generally 

 brought together with a future. There are fome prafti- 

 tioners, however, and amongil them is M. Delpech, who 

 confider the ufe of futures, even in thefe cafes, quite unne- 

 ceffary. Precis des Maladies Chir. torn. i. p. 346. 



Sabre-ftrokes, direfted obliquely downward againft the 

 face, very often produce a wound with a flap, which thould 

 be immediately laid down in its proper fituation again. 

 When the flap i? large and mufcular, Richter thinks it beft 

 to ufe a future at one or two points, as the ftrips of adhe- 

 five plafter are apt to become difplaced, efpecially if the pa- 

 tient is reft:lefs, and then the flap of flcin, not being fufB- 

 ciently retained, flips downwards, and the part is not healed 

 without deformity. However, it certainly has always ap- 

 peared to us that a future in this inftance may be difpenfed 

 with, if care be taken to aflift: the effeft of the adhefive 

 plafter with a comprefs and bandage. Firft Lines of the 

 Praftice of Surgery, p. 291. edit. 3. 



Sabre-wounds fometimes break and fplinter the bones of 

 the face. The frafture, however, feldom extends far, be- 

 caufe moft of thefe bones are foft and fpongy. Notwith- 

 ftanding fuch injury of the bones, the wound of the foft 

 parts frequently admits of being united, if care be taken to 

 extraft all the fplinters, and put the furfaces of the divifion 

 of the bones as evenly together as poffible. Unlefs the 

 fragments are quite detached they fliould never be taken 

 away, but be replaced as well as circumftances vnll permit. 

 Their removal is not an eafy matter, it oceafions an unplea- 

 fant disfigurement, and experience proves that all divifion* 

 of the bones of the face heal with particular readinefs. 

 (Anfanfgr. der Wundarzneykunft, b.ii. p. 244. edit. 3.) 

 A very terrible fabre-wound of the face is recorded by Mr. 

 Hennen. The weapon ftruck an officer nearly acrois the 

 eyes, one of which it deftroyed ; it then divided the parts 

 downwards and inwards to fuch an extent, that the pharynx 

 could be feen. Yet the injury healed in a very favourable 

 manner, as indeed do all wounds of the face, owing to its 

 great vafcularity. See Obf. on Mihtary Surgery, p. 370. • 



In fome horrid cafes, where the lower jaw is fwept away 

 by a cannon-fliot, life is preferved ; but, in general, the pa- 

 tient finks under the accumulated tortures of his fituation. 

 " It isftill, however, ourduty,"as Mr. Hennenobferves, " to 

 try every expedient ; and after the ragged parts and fplinters 

 of bone are removed, the veffels within reach fecured, and 

 the fuppurating procefs fairly eftabUlhed, we may endeavour 

 to aflift nature, faithfully following any effort (he may make 

 to fill up the chafm, but without allowing ourfelves to count 

 upon a fhowy or complete cure." (Op. cit. p. 373.) This 

 gentleman faw a horrid-looking cafe, in which nearly one half 

 of the face was carried away by a round fiiot at Waterloo, in 

 a very fair progrefs of contraftion. Larrey has likewife re- 

 corded a fimilar cure ; and the writer of this article once 

 witnefled in Holland a moft extraordinary recovery of the 

 fame nature. It was the cafe of a foldier, wounded at the 

 affault of Bergen-op-Zoom, in 18 14, who was afterwards 

 brought into one of the military hofpitals of Oudenbofch. 

 All the lower jaw, and a large part of the upper, were in this 

 inftance completely torn away. There was very httle he- 

 morrhage, and no vcfTels required the ligature. 



For fome obfervations on wounds of the tongue, we beg 

 to refer to the article Tongue. 



When a part of the nofe is divided, but not entirely de- 

 tached, it is the duty of the furgcon to replace it as expedi- 

 tioufly as poffible. When adhefive plafter does not appear to 



be 



