223 
TREATMENT OF WOUNDS OF THE CHEST-WALL. 
discharges are liable to burrow in the loose connective tissue which 
surrounds the great vessels, the trachea, and oesophagus, and may 
extend into the chest, causing septic pleuritis. Wounds complicated 
with fracture of the first rib often produce similar results. The great 
vessels of the neck and the nerve-stems (vagi) may, moreover, be 
affected, endangering fatal bleeding or paralysis of the larynx. Violent 
shocks to the chest-walls may injure the axillary vessels and nerves and 
produce paralysis, while similar conditions also occur in fractures of the 
scapula and humerus. Wounds complicated with fracture of the scapula 
and humerus are usually fatal, septicaemia soon appearing, either in 
consequence of direct infection of the wound or of the animal continu¬ 
ously lying down. Coldness and paralysis of the affected limbs point to 
thrombus formation in the vessels, while paralysis alone suggests injury 
of nerve stems. Such serious results are, however, in great part pre¬ 
vented by the protection afforded by the stout thoracic fascia. Where 
the shoulder-joint is not injured, mere muscular wounds often heal well. 
Even where the wound passes under the shoulder, as far as the anconei, 
recovery usually occurs without affecting the movement of the limb. 
The lameness is important in forming a prognosis : as long as it is 
not marked, and no severe symptoms of fever exist, healing may be 
expected, even where the muscles are extensively lacerated. Danger of 
pleurisy is not great. The emphysema sometimes occurring in these 
muscular lesions must not be supposed to depend upon the thorax 
being perforated; nor must moderate acceleration of breathing, deter¬ 
mined by injury of the accessory respiratory muscles, be mistaken for 
pleurisy. 
Treatment. After bleeding has ceased, the wound should be carefully 
examined to discover its extent and the possible presence in it of foreign 
bodies, which, if present, should be carefully and thoroughly removed. 
The parts are then cleansed; in deep injuries of the anterior surface of 
the chest, extending towards the middle line, particular provision must 
be made for the escape of wound discharges in order to prevent the 
formation of sternal fistulse. It is well to lay open any pockets or make 
counter openings. Drains or setons are introduced if required. Where 
larger vessels, especially veins, are exposed, after-bleeding may result 
during the first three days, but seldom later. It is, therefore, advisable, 
whenever possible, to ligate injured vessels, to fill large wounds with 
antiseptic tampons, and to watch valuable animals continually. Per¬ 
manent irrigation with lukewarm antiseptic solutions should be continued 
for several days (sublimate 1 in 3,000, carbolic acid or creolin 1 in 50). 
Cold solutions should only be used while bleeding persists. Where 
continual irrigation is unattainable, the wound must be rinsed out 
carefully every hour or two with a disinfectant. Similar methods of 
