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Show dbuw uwmu VVOUNDS FROM CANNON-SHOT. ‘DISTINCTIONS FROM PARTS WOUNDED. body in the wound is not felt nor followed by inflammation, whilst this eschar is formed by the attrition of the ball: those parts contiguous to it, which remain alive, are yet benumbed, and there is a pause in their action before they begin to inflame. This is a period in which the surgeon may use freedom with. out any risk of giving pain. But even at this stage, a teazing interference and frequent probing or incision Will accelerate the inflammation, and bring on an action too early, and before the sound surface is disposed to separate from the sloughs : it may , consequently, produce a violent inflammationas. With the rising of the inflammation, what was like a plug choaking the wound, begins to gleet and discharge. By and bye, about the sixth 01‘ seventh day, the slough protrudes from the wound, and suppuration is established. The dead parts have, in all probability, separated, but they still remain in the wound a source of irritation,so as often to obstruct the discharg which ought now to be free. If the discharge be free, the gra- the part; the patient is taciturn and pale, with his eyes fixed; the wounded limb is pale and colourless, and without feel'ng. Here we are enjoined to restore the sensibility of the limb and the powers of the system, store any operation be attempted. When, however, we are freed from anxiety on account of this nulations will soon shew themselves, and the wound retain no further peculiarity of the gun-shot wound than its depth and narrowness. Now it has become a tube alive in all its extent, and if any piece of cloth or sharp point of bone remains, they keep up an irritation and a gleety discharge instead of good pus'r. g. I: it I,I .1 -. -_,_t.;.- . u" LJ.i In SHATTERED LIMBS, and in \VOUNDS wrrn caxxoxsnor in their first stage, and in complicated wounds with GRAPE, re» . .-,,«., 1-. ha-.- ,_ -,, quiring amputation or operations with the knife, there is a Cl!" cuinstance which must be distinguished as peculiar.--The bemunbing and cold indolence proceeding from the concussion of * In like manner, when the bone is shattered by the piece beingr driven amongst the flesh, amore immediate inflammation is occasioned; for lbc wounds made by the bone are like common wounds, and the spicules lie in parts vascular, and capable ot‘immediate action. "'hen wounds have passed the violent stage of inflammation, scarificniions produce a change favourable for healing, in consequence of a new ac- Fan‘s" ~.,..«..~. -;:.~n< . tion excited in the cuts, and by sympathy and the direct communication of inflammation to the whole surface ofthc torpid sinuses. 1* Chile complication C-f‘gulhshOt and tincture, sc c the title rnACTcnnB 25 nervous affection of the limb, and 0f the constitution, we have to dread the over action of the parts and of the system, and must endeavour to retard the violence of the accession, and re- strain the high inflammation. By bringing the inflammation mildly forward, we ensure a happy suppuration, and the separation of the injured parts. The last peculiarity of gun-shot wounds which I shall enumerate, is the possibility of hzemorrhagy coming on when the suppuration is established, and the slough is throwing oil'; for the bullet may have grazed a large artery, so as to destroy the coats without intercepting the flow of blood through it ; and, conse iuently, when the 5101} "h is thrown oil, the blood , bursts out unrestrained. When good suppuration is established, all distinction of in... wounds, so far as proceeds from the nature of the original , a. l , . (jury, is done away; and the sore pecuhaiitis which ien ain, have reference to the nature of the parts wounded. Here the intelligent knowledge of anatomy is that which aione can give confidence to the surgeon, or enable him to perform his duty to his patient. For example, the character and dangers of wounds of the head, of the lungs, and of the abdomen, the wounds of great arteries, and the complication of fractured bones and open wounds. The dill‘ercnce of wounds in tendinous parts and muscular flesh, of parts covered and bound down by strong fascia, or of a muscular part which is left free to assume the necessary degree of tumefaction'it. * By the intelligent knowledge of anatomy, Imeannotaknowledge oi" vessels in their course merely, but of their relative situation ; of the peculiaritv of structure and function ofparts ; and of the distinctions which mark theni under disease. This kind of knowledge forms the subject of the air. thor‘s lectures on the living body. He shows the probable course and direction of wounds: thcparts through which they will naturally take they; 303311", "UP. I. l". a ‘in \nInJC‘r ' . I |
