WOUNDS. 



be capable of fecuring'the part in its proper fituation, a future 

 may be employed. Writers ufually advife keeping the nof- 

 trils pervious with foft flexible tubes, chiefly with a view of 

 giving vent to the mucus which is fecreted by the inflamed 

 Schneiderian membrane, and which, if it could not readily 

 efcape, might prove exceedingly annoying to the patient. 

 Putting out of the queftion Garengeot's extraordinary cafe, 

 and a few others to which we have already adverted in a pre- 

 vious part of this article, we have many fafts on record, 

 proving not only that moft incifed wounds of the nofe ad- 

 mit of union, but alfo that contufed ones, attended with an 

 abnotl complete detachment of the part, may often be 

 united. In one inftance, the cartilaginous portion of a 

 young man's nofe was nearly bit off by a horfe, the fepa- 

 rated piece only hanging by a thin portion of llcin ; yet 

 after being replaced, and three ilitches made, the part was 

 united without any material deformity. Richter's Chir. 

 Bibhothek, 6 band, fcite 538, and Cooper's Firft Lines of 

 Surgery, p. 282. edit. 3. 



As the parotid duft pafles beneath the integuments of the 

 cheek over the mafleter mufcle, it is much expofed to 

 wounds, which, if not properly treated, end in what are 

 termed falivary fiftulae. Having confidered this fubjeft in a 

 feparate article, (fee Salivary Fistula,) we (hall not dwell 

 upon it at prefent. A late writer informs us, that in injuries 

 01 the parotid duft he has fometimes derived advantage from 

 making the divifion complete by a clean incifion acrofs the 

 duft into the mouth, and clofely bringing together the edges 

 of the wound on the outfide of the cheek. The natural 

 flow of faliva into the mouth kept the wound from healing 

 up on the infide of the cheek. Hyinen's Military Surgery, 



P- 374- 



With refpeft to wounds of the external ear, experience 

 has fully proved that they are cafes which ufually terminate 

 favourably. Incifed wounds and fabre-cuts of the ear moftly 

 heal extremely well. Ravaton has recorded a cafe in which 

 the ear united again, although it had been nearly feparated 

 from the head ; and another inftance of fuch fuccefs is men- 

 tioned in Cooper's Dift. of Surgery, art. Wounds. Thefe 

 and many other fafts which might be quoted leave no doubt 

 of the propriety of always making an attempt to unite 

 parts, whenever the leaft conneftion between them remains. 



Surgical authors differ in their ftatements about theeffefts 

 of the total lofs of the external ear upon the power of hear- 

 ing. Thus it is afierted by M. Richerand, that the exter- 

 nal ear, which is a fort of inftrument calculated for concen- 

 trating the rays of found, may be totally cut off without 

 deafnefs being the confequence. For a few days after the 

 lofs, he fays, the hearing is rather hard ; but the infirmity 

 gradually diminiflies, the increafed fenfibility of the audi- 

 tory nerve compenfates for the imperfeftion of the organic 

 apparatus, and the acutenefs of the fenfeis entirely reftored. 

 (Richerand, Nofographie Chirurgicale, torn. ii. p. 122. 

 edit. 2.) However, if we are to credit the ftatement of 

 other writers, the recovery is far lefs complete than M. Ri- 

 cherand reprefents it to be. Thus Lefchevin notices, that 

 fhey who have loft the external ear, or have it naturally too 

 flat, or ill-ftiaped, have the hearing lefs fubtile. The defeft 

 can only be remedied by an artificial ear, or an ear-trumpet, 

 which receiving a large quantity of the fonorous rays, 

 and direfting them towards the m.eatus auditorius, thus 

 does the office of the external part of the ear. Prix de 

 I* Acad. Royale de Chirurgie, torn. ix. p. 120. edit. i2mo. 



Wounds of the external ear, whatever may be their fize and 

 fliape, do not require a different treatment from that of the 

 generality of other wounds. The re-union of the divided part 

 it the only indication, and it may be in moft inftances eafily 



fulfilled by means of methodical dreflings. Such writers at 

 have recommended futures for wounds of the ear, ( fays Le- 

 fchevin, ) have founded this advice upon the difficulty of ap- 

 plying to the part a bandage that will keep the edges of the 

 wound exaftly together. The cranium, however, affords a 

 firm and equal furface, againft which the external ear may 

 be conveniently fixed. Certainly, it is not more eafy to fe- 

 cure dreflings on the nofe than the ear ; and yet cafes are re- 

 corded in which the cartilaginous part of the nofe was 

 wounded, and almoft entirely feparated, and the union was 

 etfefted without the aid of futures. See Mem. de M. Pibrac 

 fur I'Abus des Sutures, in Mem. de I'Acad. de Chir. 

 torn. iii. 



In wounds of the ear, then, we may conclude that futures 

 are generally ufelefs and unneceflary. As examples may 

 oecur, however, in which the wound may be fo irregular and 

 confiderable as not to admit of being accurately united, 

 except by this means, it fliould not be abfolutely rejefted. 

 An enlightened furgeon will not abandon altogether any 

 curative plans ; he only points out their proper utility, and 

 keeps them within the right limits. When fticking-plafter, 

 fimple dreflings, and a bandage, that makes moderate pref- 

 fure, appear infufficient for keeping the edges of a wound 

 of the ear in due contaft, the judicious praftitioner will not 

 hefitate to employ futures. 



When a bandage is applied to the external ear, it fhould 

 only be put on with moderate tightnefs, fince much preflure 

 gives confiderable uneafinefs, and may induce (loughing of 

 the partv In order to prevent thefe difagreeable effefts, 

 M. Lefchevin advifes us to fill the fpace behind the ear with 

 foft wool or cotton, againil which the part may be com- 

 prefled without rifk. Op. cit. p. 119. 



In the application of futures, the ancients have cautioned 

 us to avoid carefully the cartilage, and to few feparately, 

 one after the other, the fliin of both fides of the ear. They 

 were fearful, that pricking the cartilage would make it mor- 

 tify, " ce qui eft fouvente-fois arriv6," fays Pare. But 

 not^vithftanding fo refpeftable an authority, the moderns 

 make no fcruple about fewing cartilages. In wounds of the 

 nofe, Verduc exprefsly direfts the fliin and cartilage to be 

 pierced at once in applying futures, and the fuccefs of the 

 plan is put out of all doubt by a multitude of fafts. The 

 fame treatment may alfo be fafely extended to the ear. See 

 Lefchevin's Obf. in Op. cit., and Cooper's Dift. of Praft. 

 Surgery, art. Ear. 



Wounds of the Throat. — As Mr. John Bell has obferred, 

 there are feveral anatomical points which fliould be well 

 remembered by the furgeon in all cafes of wounds about the 

 throat. Firft, it is to be recoUefted, that the arch of the 

 aorta lies in the upper part of the cheft in front of the tra- 

 chea ; and that where the carotid arteries come out of the 

 cheft to go up along the neck, they are fcarcely at the fides 

 of the trachea ; they rather run before it. But, that as the 

 arteries mount up the neck, they incline more to the fide of 

 the trachea ; and that at the upper part of the neck, they 

 are entirely behind that tube ; for they inchne towards 

 the angle of the lower jaw, and having reached it, they 

 begin there to give off^ their branches both to the head and 

 neck. Hence we fee the reafon why a wound at the lower 

 part of the neck is very often fatal, while a wound higher 

 up is generally lefs dangerous. The fuicide feldom ftrikes 

 at the lower part of the neck ; and it is from the accidental 

 circumftance of his cutting very high up, near the chin, 

 that the carotids efcape. 



Secondly, as the fame author has explained, it ftiould be 



remembered, that the carotid artery, the great jugular vein, 



and the par vagum, or eighth pair of nerves, lie very clofely 



12 connefted 



