SURGERY. 
practice, unless abscesses, or extracting 
foreign bodies sliould demand it. A sooth- 
ing plan, by means of emollient poultices, 
&c. is preferable. 
Lacerated and contused wounds, on ac- 
count of the violence attending their inflic- 
tion, do not unite tike simple cuts by the 
first intention. Yet they should be brought 
together, and inflammation obviated by the 
appropriate treatment. 
If a wound does not unite by the first in- 
tention, it must grannlalte and cicatrize. 
Pus is secreted from its surface, which be- 
comes red and pneven, rising into little 
protuberances, called granulations. These 
fill up the cavity of the wound to a level 
with the skin, which then grows over and 
covers them by a newly-formed smooth pel- 
licle, termed a cicatrix. Wlien this process 
is completed, the newly-formed part is ab- 
sorbed to a great degree, and hence the 
surrounding healthy skin is drawn from all 
sides over the situation of the wound, pre- 
senting a puckered appearance. 
Gunshot wounds are attended with great 
laceration and violence, insomuch that the 
parts in their track are killed, and must be 
thrown off in the form of sloughs. They 
are very often complicated with fractures, 
wounds of arteries, viscera, &c. and with 
the introduction of foreign bodies, as balls, 
portions of clothing, &c. 
Immediate amputation is often necessary 
in gunshot wpiinds of the limbs; and often 
there is much doubt whether this means 
should be adopted or no. It may be done 
immediately after the accident, before sup- 
puration, fever, &c. have supervened ; or 
when the violent inflammation, swelling, 
&c. have abated. By deferring it to the 
latter period, the surgeon has often a chance 
of saving the limb ; and if he does not suc- 
ceed, he operates under more favourable 
circumstances, as a patient habituated to 
disease bears an operation much better 
than a person in good health. Yet this is 
pot meant as an argument against imme- 
diate amputation in any case ; for by that 
practice a simple incised wound is substi- 
tuted for a complicated lacerated one ; and 
the constitution escapes that hazard which 
repeated suppurations, painfiil incisions, 
&c. are inevitably attended with. Besides, 
after the constitution is nearly ruined by 
the processes of recovery from a dreadful in- 
jury, the limb is often no better than a 
wooden one. 
Incisions at the entrance and exit of the 
ball are not necessary, unless there is an 
object to be accomplished. Foreign bodies 
.should be extracted if it can be done easily; 
but tedious examinations and incisions are 
improper, particularly when the belly or 
chest are w'ounded. The mildest dressings 
and treatment should be employed. Fomen- 
tations and poultices, and dressings of white 
cerate, answ'er every end. 
Poisoned wounds. The stings of bees. See. 
the bites of gnats, and other insects, are 
treated by cold applications, and attention 
to the constitution if the general irritation 
be great. In the bite of the viper, alarm- 
ing symptoms usually arise ; viz. swelling, 
heat and pain of the limb ; small and weak 
pulse ; head-ache and vomiting, &c. Per- 
haps excision might be proper at the very 
fii'st; or, at all event®, the wound should 
be carefully cleansed. Emetics, and vola- 
tile alkali, have been commended as con- 
stitutional means. 
Hydrophobia arises from the bite of a 
mad-dog, or other rabid animal. The 
wound heals, but in about three weeks a 
dull pain is again felt in it. Dejection of 
spirits appears at the same time, followed 
soon by the dread of water; and intoler- 
able sense of suffocation and convulsions at 
any attempt to swallow fluids. Horror of 
the countenance, redness of the eyes, con- 
vulsive and violent movements, &c. con- 
tinue to the time of death. Excision of the 
bitten part is the only preventive ; it should 
be employed at any time previous to the 
accession of symptoms ; the use of caustic, 
&c. is very uncertain.' No remedy is of 
the least use when the symptoms have 
appeared. 
Contusions, when slight, may be treated 
by cold applications, and quietude of the 
injured part. In other cases, topical bleed- 
ing, followed by discutient lotions, as sal 
ammoniac in vinegar and water, or fomen- 
tations of hot vinegar, and afterwards cam- 
phorated liniment, are required. Purging 
and venesection are sometimes necessary. 
Polypi are fleshy excrescences, growing 
from a thin pedicle, and occurring most 
commonly in the nose and uterus. Those 
of the nose are divided into the fleshy, or 
benign, wiiich are white, soft, and unat- 
tended with pain ; and the malignant, which 
are hard and painful, and according to some, 
of a carcinomatous nature. They grow most 
frequently from the spongy bones; occa- 
sion at first an obstruction of the nose, and 
gradually fill up the whole cavity; extend 
backwards to the throat ; expand the nostril 
by elevating the os nasi ; destroy the other 
