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Show £ONIUSIOX. 1 11/ 1111111111. 50W , tNUtA firm and resisting, the injury sometimes falls upon the surface of the bones; or at least the soft parts immediately attached to the bone, are more injured than the elastic and yielding parts which lie more upon the surface. The consequence of this is, that sometimes concealed suppuration arises from bruises of fleshy parts, in which there appears little outward rriarlr of injury 91% I have said, that in aeontusion the nerves are injured. This also requires some further illustration. This injury of the nerves gives a degree of dullness to the sensation, which immediately succeeds the accident; but afterwards it is the chief cause of the inflammation and pain. Further, the most inexs perienced man has seen the eliect of what is termed a concus~ sien of the brain, and knows that this injury of the substance of the brain is followed by an interruption of its function Precisely in the same way does it happen, thonghIn a lets d: gieeintl,11e concussion of the nervous system of a limb. Thus, large stones thrown with great force, spent cannon balls, the beam of 111ae.1inery in full motion, striking a limb-are some times attended with little pain, swelling, or discolouration : ‘._~12.§~x.-‘e"i"‘ ‘=' and even angrene pr:1eedes high action. It is the same efi‘ect "In my Lectures, I am in the use of giving a series or case .1 in illustration beginning with this. A boy, While lying ash ep on the gr ound, was t101' upon ly the foot ofa fellow \.1t11 (10:11:12 1.1.oedeu shoes When I saw the boy it was after some day s ‘11.11:.1c1u1 iating pain, followed b1 shivezin'r and15v(:1, the thigh had become enormously 111fllPl l,out not in the sliuhtn :~..-_~ ;-...wr1 .1... 5‘"qu- *"1‘ 1" '- 1252111:*1 e1, discoloured 'I he swelling 11 astens e and elastic, and such as 111'as 1 cry like the nere turnefaction oflhe inflam ed muscles bound down by the lhseia. Imagining that matter 111in it be forming under the fascia, I made :1 Still suspectingn'wh'.it had'11app:11 («1,1 pushed'an abscess--lmeet deep into the 111' ound, and mash it gra e upon tie 111:1. e, \1l1en‘1he matter appeared. ltl 1en introduced a 1 3th! lcr, and :11t puncture into it, but no matter flows:1 . {tr 1\'11ds :1 5111 er in l1,e hy uhic h I complet ely emptied. ti; o th eh of thet 111'"EU‘ \shleh 111m been tormedin consequ eme oi the inju =; 80ft 13111451 ~11:11111'151110‘113 to the bone. lki.ow by e:.iperi euce (113111111 0111', a 112'v (lays l1?lore seen the dissection of a 111'111 who 1l.'icdr1 1, c011s<qurnee 01":1blow 11 1t111 l 4 1121111 , on 1‘2111: lorepart of theLi = ) that iriis mater 11.011111 Q111Ed;1 113161 inane 1111; bone 031.0111; lied this p 11b," 53 on ti: {1. he: 1.0 :1: 1'1 311101" 1 ms 111211 l1idcpen by incision, the boy could 110211.115 sun'iiui: 1 l -. 1 lammot 1011. '1'1111 11 1 3121‘ h'11e11111011'cd 'niuszhau destl'o1 6 CONTUSION. which we every day see when a man lies with a bad concussion of the brain and bruise of the scalp. The low state of the sys- tem, proceeding from the injury of the brain, prevents the in« flammation or swelling from rising suliicie fly to shew us the place of the injury. If our patient has suffered contusion by failing, the first of; feet is a shock to the whole body1 and there is sickness, lain, guor, faintness, and dehilitytt,- then succeeds pain,stillness, and rCVCI'. The part injured swells sloulv, on1d f1mm the ecchymosis thereIS marbled, blackland purple colour. .l‘o11'a1ds the fourth and lift11 day, there is softness in the centre, and around it there arises a hardened ring of inflammation. This softness1n the centre might be mistaken for suppuration, and a. collection of pus: but it is not; and if it be punctured, the wound 111 ill not heal kindlyi'. The patientin this stage should be strictly attenc ed to,' for either there1s an absorption of the extravasated fluid, and gradual diminution of the inflammation, or there1s suppura~ lion. If the injury is not very severe; if no parts are deeds med by the bruise, and the extravasation is not too e'rea then the vesse1s throw out aser 111s eliusion, \1'11ieh,diluting' the extravasatcd blood, both are re-absorbtd. This liquid state of the em. 1-1.1 1e'1111'151le1the Clit‘ft t of suppuraiionjj, 1' In this state the landlady gives her dram ; the surgeon bleeds ; now, i think in this stage the landludy is right. f It is very important to observe this harder ring‘ and soft centre in contue sions ofthe head. The soft centre has often been taken for a depression of the skull, and the scalp cut open. :1- Ifthe injury of the part be very great; if' there does not appear- to he tumefaction in :1 degree natural to the injury ; audit we fear gangrene before the parts recover themselves, and the vessels are excited ; or ifwe have any alarms on account oft‘ne constitution oftlre man, perhaps a debauehee, or :1 dissolutc, drunken fellow, who has fallen from his cart; then we use flannel, with hot and spiritous fornentations. If the parts have taken an undue 21c- ‘1ion, and we wish to soothe and moderate it, then we must use leeches, cold 1 loths, 11nd cold sp111to11s applications, which excite the surface gently, 9111:! 1'11. the same time take oil the heat by evaporation. Lastly, if suppuiutiouhe begun, and we wish to induce1'1 healthv action, end to bring" the maker to the 551 "face, We must comm: :c neat l1. ho‘'11 131'rm. 2",: Stillflll'lirt 13.11 111m ""1 |