A punctured wound signifies one made with a narrow pointed instrument, the external orifice of the injury being small and contracted, instead of being of a size proportionate to its depth. A wound produced by the thrust of a pitchfork or nail affords an example of a punctured wound.

Wounds of this description are in general infinitely more dangerous than cuts, notwithstanding the latter have the appearance of being by far the most extensive. In stabs the greatest degree of danger always depends on the injury and rough violence which the fibres have suffered in addition to their mere division. Many of the disagreeable results are also imputed to the considerable depth to which these wounds extend, whereby numerous textures, important parts, and organs are frequently injured.

Again, it sometimes occurs that the treatment is rendered perplexing by the difficulty of removing extraneous substances - as, for instance, foreign bodies may be carried into the wound at the time it was inflicted; and lastly, experience proves that punctured wounds are particularly liable to be followed by a great deal of inflammation, fever, deep-seated abscesses, and sinuses. In fact, some authors regard a punctured wound as a recent sinus, and in order to make the inner surfaces unite, they recommend exciting inflammation in them, either by means of setons or injections.

Now the time when incisions are proper is when there are foreign bodies to be removed, abscesses to be opened, or sinuses to be divided. But to make painful incisions sooner than they can answer any end, is both injudicious and hurtful; in fact, they are sometimes rendered quite unnecessary by the union of the wound throughout its whole extent, without any suppuration at all

Making, then, a free incision in the early stage of these cases undoubtedly seems a reasonable method of preventing the formation of sinuses by preventing the confinement of matter; and were sinuses an inevitable result of all punctured wounds, for which no incision had been practised at the moment of the occurrence, it would undoubtedly be unpardonable to omit them. Fair, however, as this reason may appear, it is only superficially plausible, and a little reflection soon discovers its want of real solidity. Under what circumstances do sinuses form? Do they not only form where there is some cause existing to prevent the healing of an abscess? This cause may either be the indirect way in which the abscess communicates with the external opening, so that the pus cannot readily escape; or it may be the presence of some foreign body or carious bone; or, lastly, it may be an indisposition of the inner surface of the abscess to form granulations, arising from its long duration, but removable by laying the cyst completely open. Thus it becomes manifest that the occurrence of suppuration in punctured wounds is followed by sinuses only when we neglect to procure a free issue for the matter after its accumulation, or when we neglect to remove any extraneous body.

Now as dilating the wound at first can only tend to augment the inflammation and render the suppuration more extensive, it ought never to be practised except for the direct object of giving free exit to matter already collected, and of being able to remove foreign bodies palpably lodged. And here let me observe, that it is an erroneous idea to suppose the narrowness of punctured wounds to be so principal a cause of the bad symptoms with which they are often attended, that the treatment ought invariably to aim at its removal

In the first stage, then, of a punctured wound, the indication is to guard against the attack of violent inflammation. When no considerable quantity of blood has been lost, a little local bleeding is beneficial. And as no man can pronounce whether such a wound will unite or not, and as no harm can result from the attempt, the orifice ought to be closed, and covered with simple dressings: but whether gentle compression might be made to promote the adhesive inflammation or not, may be doubtful. However, perfect quietude must be observed, and if the pain is severe, opium is to be administered, followed by a purgative.

Sometimes under this treatment we are agreeably surprised to find the consequent inflammation mild, and the wound speedily united by the first intention. Indeed, numerous examples of wounds which penetrate the large cavities are found healed by the first intention, that is to say, without any suppuration. But in deep stabs the pain is intolerable, and the inflammatory symptoms run so high as to leave no hope of avoiding suppuration. In this condition emollient poultices and fomentations are the best local remedies. And when the matter is formed, the treatment is like that of abscesses in general