Simple incisive wounds will usually heal by the first intention, that is, the incised parts on being brought together unite directly without suppuration, without much if any functional disturbance; but punctured, lacerated, or gunshot wounds generally suppurate, new granulations forming, thus healing by the second intention, and when they are deep and extensive, give rise to considerable fever. Thus punctured wounds in any part of the body, sometimes made by the thrust of a sword, bayonet or knife, or in the foot by treading on a nail, are often exceedingly painful, and not unfrequently give rise to lockjaw. In gunshot and lacerated wounds the surrounding parts are often seriously injured, and the pain and fever which accompany them severe. In the punctured, lacerated or gunshot wound, and sometimes where the parts are very much contused, for want of 19 proper reaction in the system, mortification may take place.
Our object of course in the treatment of all wounds is to heal them up quickly and prevent as much functional disturbance as possible. Incised wounds bleed freely, but lacerated or gunshot wounds seldom cause much haemorrhage, even though large blood-vessels are injured.
In all wounds the parts should be carefully examined, to see that there are no foreign substances present, such as glass or dirt. The wound should be washed with cold water and any foreign substance which is not removed by this process carefully extracted. Steps should be taken to control the haemorrhage. This can often be done by pressing the parts together with the fingers, bathing them with cold water, with which may be mixed a little Arnica, or Kreasote may be placed on the bleeding parts. If, however, one of the arteries is severed, which may be known by the bright red blood spouting out in jets at every pulsation of the heart, and the bleeding cannot be controlled in the way indicated above, the current should be shut off by compressing the artery above the wound. The location of the artery can generally be ascertained by pressing with the fingers on the inside of the limb, when the beat may be felt beneath the fingers. Over this spot place a piece of cork, or a pebble stone, binding around the limb over the cork or pebble, a handkerchief. Now by introducing a small stick under the handkerchief, and twisting it round, a very good tourniquet is formed, the pebble or cork is pressed against the artery, compressing its walls and checking the current of blood. Where the wound is below the knee the above application should be made in the hollow on the inside of the leg and the bend of the knee, and where it occurs in the arm below the elbow, the compression should be at the elbow. Of course a surgeon should be obtained as speedily as possible. In the cut wound, as we have before said, if the parts are brought closely together and kept in that position they will heal in a short time. This may be done, where the wounds are deep and long, by taking two or three stitches with a needle and thread, thus drawing and holding the parts together. As a general thing however all that will be required, will be the application of adhesive plaster. This should be cut in long narrow strips, so as to extend well on either side; these strips, first warmed by the fire, should pass directly over the wound from side to side, drawing the lips closely together. A small space may be left between each strip, where it crosses the wound, to permit the escape of pus, should suppuration take place. Externally the only application necessary will be Arnica or cold water.
In lacerated or contused wounds the parts may be closed in a similar manner, bathing the parts freely with Calendula, and afterward, if much heat and swelling is present, applying cold water. In deep wounds, particularly in punctured, or gunshot wounds, great care should be taken, that the healing process should commence at the bottom. If the edges are brought together the wound may heal on the surface, while no union has taken place below. To prevent this, lint should be introduced into the wound, keeping the upper portion open while the healing process is going on at the bottom. This lint should be removed daily, and the parts washed with tepid water.
If considerable fever should set in, Aconite should be given once in three or four hours. If the parts are swollen and exceedingly painful, Belladonna may be given at the same intervals. Where the suppuration seems unhealthy, a powder of Hepars. may be taken in the morning, and of Silicea at night.