These wounds heal much more slowly, as a general rule, than either incised or punctured wounds, never uniting by what is termed dry or primary union, in which no pus is formed, the parts adhering together at once, leaving no scar. These wounds heal by a process known as granulation, or secondary union, which is accompanied by more or less profuse discharge of pus. When the granulations which are formed in the process of healing grow so rapidly as to fill up the wound and aperture above the sur rounding tissues, we have what is known as proud flesh. The new skin destined to cover the wound is gradually formed about the outer edge, extending inward until the whole is covered. The new tissue formed by this process of healing contracts after the healing process is complete, and forms what is known as scar or cicatricial tissue. Scar tissue becomes after a time like the tissue in which it is produced.

Still another method of healing which is sometimes illustrated in this class of wounds, as well as others, is that known as scabbing. This is a process by which the repair of the injured part takes place very rapidly in a manner similar to that seen in primary union. No granulations are formed, but a protective substance is thrown out which when dry forms what is known as scab, beneath which the repair of the injured parts takes place. Artificial scabs may be formed in a clean fresh wound by moistening a bit of lint in fresh blood and placing it over the injured part.

The wound should be thoroughly cleansed as in other cases, and the injured part should be drawn together by means of plasters and bandages. Care should be taken not to employ too strong compression. Either water-dressing or lint saturated with sweet oil containing ten drops of carbolic acid to the ounce, may be employed. If the parts have been badly bruised, hot fomentations should be applied. Heat is especially essential in cases in which considerable portions of tissue have been nearly severed from the body, but have retained a sufficient amount of attachment to justify the attempt to secure union.

For contused wounds, carbolated vaseline, containing ten drops of carbolic acid to the ounce, constitutes an excellent dressing. It should be spread upon a piece of thin cloth and then applied to the injured parts.

If considerable sloughing occurs through the death of the tissues, the parts should be thoroughly cleansed two or three times a day with fine castile soap and water, followed by a one per cent solution of carbolic acid. Portions of the limbs are sometimes so badly torn and mangled that healing cannot take place. In this case the injured part must be removed by amputation. It should be borne in mind, however, that nature's resources are often much greater than might be considered possible, parts apparently irreparably injured being restored to a very useful condition. Hence, when there is even the barest possibility of saving the injured part, amputation should not be performed. We have known instances in which individuals have resisted the advice of the surgeon who urged amputation, and have recovered with useful arms and legs, who otherwise would have been maimed for life. Recovery is especially likely to occur from severe injuries of the hands and feet.

Dr. Frank Hamilton, of Bellevue Hospital, New York City, has secured some remarkable results in these cases by continuous immersion of the injured part in warm or hot water, the temperature being maintained at 100 or a little above. When there is a marked disposition of the injured parts to become gangrenous or to slough, hot fomentations should be applied, or the parts should be immersed in water as hot as can be borne. Some surgeons have ridiculed this process of "maceration," as they are pleased to term it, but Dr. Hamilton, has so thoroughly demonstrated its utility that it is now recognized as one of the most useful means of treating badly lacerated limbs. It is of course necessary that the water should be changed frequently; three or four times a day is none too often.