OCR Text |
Show LACERATED WOUND. l'UNCTURED WOUND. After this high inflammation, there comes deep suppuration, with sinuses running amongst the muscles, destroying the con necting cellular membrane, and requiring counter openings for their cure. The discharge is not of the consistence of cream, yellowish, and without factor, which is the character of pm, and such as we meet with in the instance of an open and. healthy wound. For the treatment of these penetrating wounds, more judgment and knowledge of anatomy is requir‘ ed than in the cure of the others. The great point in these deep wounds of the limbs (putting aside for the present all considerations of the haemor rhagy) is to attend to the strength and connexions of the fascia, or ten dinous expansions which cover the limbs (and here I would refer to a full consideration of the anatomy of the muscles and fascia.) For example, if a man has received a thrust through the back of the arm (the triceps,) or through the back and inside of the thigh, or through the flesh of the shoulder-- the swelling which proceeds from this penetrating wound will have full freedom and there will not be the great pain in the 5.151%. , w,‘-.: ---<-«- "35a- 07' r1n; .1 a w .. any." h"... - _-, .. »‘ «pg-W 734-3-99" my mum instance, nor the confinement of matter, tension and distress, which arise {mm a wound of the same nature passing up the forearm, or on the outside of the hip-joint, and under the great fascia of the thigh or leg. Thus, in the cure of every wound, to have a thorough knowledge of the nature of the inj u~ ry, and to form a true prognostic, we must conih'n e the know ledge of the course and form of the wound, with a knowledge of the structure of the parts through which it takes its course PUNCI‘UKE. Tins wound is a species of the last ; but I choose to make .‘1 distinction, because here there is little if any cutting; the flesh and fibres are not divided, but separat ed as by a needle, a sharp piece of wood, a bone, 83:. The inju ry in this case may fall on the nervous sys cm, producing teta nus; or in bad COB:stitutions, there may arise, from an app arently trifling wound a very high and dangerous inflatnmz. 1 attended with high 2" irritability and fever. The limb swells enormously , and the tendinous sheaths have an exudation in them which often leaves stiffness and adhesion, and contraction of the joints*. Wounds of this kind sometimes produce a pecul iar affection of the lymphatic vessels, marked by a red line on the skin, above the course of the lymphatic which is affected, and by a tenderness in the corresponding glandf. When the effect of a wound is not entirely ascri bable to the injury, as in the instance when the patient is pale and agitated, I think I have, with good effect, treated him as in the first attack of fever, by endeavouring to rouse and correct the tendency of the system. I have given a vomit , and then a stimulating draught of warm wine and aromatics, or an opiate ; and instead of endeavouring to subdue the action of the part, I have applied stupes and warm spirituous fomentation to the wound. LACERATED \VOUND. in!" Seen is the wound which a man receives when he falls on a stake, and the parts are torn up; or when gored by a bull, the horns entering the flesh and tearing up the muscles and tendon ; or when a limb or part is torn off by mach inery. The most striking peculiarity of this kind of woun d is, that it does not bleed; which is thus explained: The injury consists not in the mere separation of the parts, as in a cut, but in the SiI‘CtCik '* Such in two instances has been the fate oi'my companions in the dissects ingiroom, from puncture with the hook . f It has been imagined by some, that a puncture may be converted into 2. common wound, by cutting it open to the bottom. This I very much doubt. ifno bad consequences follow such an every-day occurrence as the prick of '4 needle, or ofa piece of wood , who would thin k ot‘cutting r into it? If tre- nor and curryulsion follow such an apparent trifle, either the consti tution is bad, or some of the minute nerve s are touched by the 11 int, whic h would. not be relieved by laying open the wound. At all events, it soon cease s to be u. locai disease, and bring s the body into such a state, that a so 1nd, in any part, brings on a paro xysm cf' convulsion and .. her to burn the wound with the: music. or to wrath" \Alfl‘c'" w |