Wound, in surgery, is a recent and violent solution of continuity in a soft, external part of the body ; being attended with an effusion of blood. - To enter into a full discussion of the different kinds of wounds, as denominated from the parts affected, would exceed the limits of this work: we shall, therefore, first give a short account of wounds in general, and afterwards treat of such casualties, according to their particular situations.
The danger attending a wound, depends chiefly on the part which is injured, and on the constitution of the patient. If, however, the heart, any of the large internal, blood-vessels, the spinal marrow, or the brain, be wounded, the assistance of an expert surgeon ought instantly to be procured; as the event generally proves fatal. Similar consequences may be apprehended, when nerves proceeding to the heart, are materially injured.
On the oilier hand, if the wound be superficial, or what is usually termed a cut, in the upper or lower extremities, especially in the muscular part of the arm, hand, finger, or in the leg or foot, it will be advisable immediately to compress the wounded part (without examining its size and dimensions), so as to exclude every access of air, and to prevent the efflux of blood: - next, any tenacious matter, such as glue, shoe-maker's wax, gold-beater's leaf, or the common sticking-plaster of the shops shuld be speedily applied. Thus artisans, working with edgedtools, very properly treat the frequent accidents of this nature : and, though the wound may extend even to the bone, yet it will in this simple manner, be safely and expeditiously healed. Nay, daily experience evinces, that external injuries of the head, neck, breast. etc. may be successfully treated by a similar method, especially by the aid of slips of ad hesive plaster ; which, in the latter situation, must be. applied to the part during the act of inspiring; so that it may not be displaced by the alternate expansion and contraction of the muscles in breathing ; that it may prove no impediment in that important process of the animal economy. Where, however, a wounded part has been neglected, and exhibits rough edges ; or, if the skin and muscles have been lacerated, a different treatment must be adopted : in these rases, a pledget or lint dipped in sweet-oil, should be applied to the injured spot, and the whole covered with a piece of fine oil-cloth. Alter 24 hours, the first dressing may be removed, without tearing or breaking the small fibres adhering to the lint; when the pledget ought to be renewed. On such occasions, a proper bandage will be indispensably necessary, in order to promote the juncture of the lips of the wound; but, in case the latter shew a disposition to suppurate, the use of oil will be hurtful; as the wound must be treated in the manner pointed out, under the article Ulcer.
NaNNoni, an Italian; and Ar-quebusade water, by Theden, the German surgeon. - Percy advises, the following efficacious ointment : Take a small glassful of the carified juice expressed from the green leaves of the burdock, and a similar portion of almond or olive-oil: these liquids must be duly incorporated in a pewter vessel or mortar, by means of a leaden pestle. Thus, a green ointment will be obtained, which may be spread on lint or soft linen, and applied to the wound every 12 hours, or oftener. This preparation softens the callous edges of the ulcer, and cleanses the latter, while it equally promotes suppuration and cicatrization. If the fungous flesh grow too rapidly, the simple juice of burdock, without the oil, will be preferable. At each dressing, the pledget or lint may be coveres with a fresh leaf of the same plant; which may also be laid on the newly formed scar, with a view to render it more firm. - As the unguent above described is in great estimation on the Continent, Dr. UNzer adds, that it may be preserved for a considerable time, when kept in a cool place; or, for long voyages, it should be boiled, and allowed to become cold, two or three different times, till it acquire a thick consistence.
M. de Kessel, a respectable German writer, observes from long experience, that new honey spread on folded linen, affords an excellent remedy for fresh and bleeding wounds, which ought not to be washed or otherwise handled; provided they contain no foreign substances, for instance, glass, splinters, etc. If they happen to be deep, or have large orifices, the honey-plaster should be repeated every wou every four or five hours, and after some days, only once in twenty-four. - He farther states, that such application not only stops the bleeding, but also prevents inflammation, swelling, and suppuration, while it checks the growth of fungous flesh.
In all open wounds, it is an object of the first importance, that the patient, especially during the act of dressing them, breathe a pure, salubrious air ; for, a foul or contaminated atmosphere, such as that of hospitals, and crowded habitations, always increases the danger; so that small, superficial injuries have, from that source, frequently been attended with fatal effects.
Tis;ht bandages often occasion a considerable swelling of the adjacent parts : in such cases, the roller ought to be very gradually removed ; as, otherwise, the tumefaction of the compressed places will suddenly increase, and sometimes terminate in mortification. Hence, Petit recommends the bandage to be renewed every three hours, so that it may each time be less tightly fastened. - In wounds which, from their nature, cannot be speedily healed, the use of Goulard-water, or other preparations of lead, is extremely improper ; as they should, from their commencement, be dressed with suppurating remedies. Hence, in all cases of febrile heat, and external inflammation, emollient poultices, composed of the crumb of bread boiled in milk, must be instantly applied, and changed several times in the day ; or, as often as they become cold, without disturbing or touching the Wounded part with the fingers.
In order, if possible, to obviate the symptoms of inflammation, it
Will, in some instances, be advisable to draw blood from a vein of the arm or foot; to resort to opening medicines, such as neutral salts, with a few grains of nitre; to apply similar clysters ; and, on the whole, to observe a cooling regimen. Such treatment is particularly necessary, in consequence of stabs or cuts given with sharp-pointed or edged instruments, and in other wounds proceeding to interior parts. Hence, Tissot remarks, that persons who had been dangerously wounded in the chest, in the abdomen, or in the thighs, have completely recovered, by abstaining from all animal food, even from broths, salted and pickled provisions of every description ; while they subsisted for several weeks exclusively on barley-water, wort, or other mucilaginous vegetable decoctions; without using any medicines, or applying ointments. On the other hand, frequent bloodletting, as well as the internal use of balsamic drugs, or what are emphatically termed vulnerary herbs, generally tend to increase febrile heat, and consequently render the wound more dangerous than if its healing were solely intrusted to the efforts of Nature. In short, venesection will be proper only in those cases which admit of cooling repellent applications, in the very first stages of external inflammation. But, if the latter become violent, being attended with great tension, irritation, and pain, it will be proper to apply either the emollient poultice before mentioned, every three hours ; or fomentations made of elder and chamomile flowers, wormwood, etc.; or, according to circumstances, a solution of Venice soap in spirit of wine. Thus, if the inflammation cannot be resolved, and must be suffered to terminate in suppuration, the method here pointed out will be applicable ; and, in order to mitigate acute pain, KiRkland recommends warm oil to be applied ; an ancient remedy, the excellence of which is recorded in the history of the Good Samaritan. Nay, the modern Arabs heal their gun-shot wounds in a similar manner, by pouring into them fresh, warm butter.
As soon as suppuration takes place, the symptomatic fever generally subsides; but, if the latter continue to exert its, influence over the patient, this circumstance may arise from the accumulation of crudities in the alimentary canal, and which ought, without delay, to be removed by cooling laxatives. These will prove no impediment to the suppurative process, but rather tend to promote it, by abating and suppressing the fever. If, nevertheless, with the utmost precaution In the cure of wounds, the purulent discharge should take its course towards the interior parts, or enter the circulation of the blood (an event which often suddenly occurs), the inevitable consequence will be a hectic fever. Sir John PRingle therefore observes, that such an alarming effect generally follows the timid use of the knife ; that is, when the incisions have either not been made sufficiently deep, or when they cannot be attempted, as is the case in gun-shot wounds.
Foreign bodies, such as iron, lead, splinters of wood, glass, linen, etc. should, if possible, be speedily extracted from wounded parts; and, in all serious accidents of this nature, surgical aid ought to be pro-cured without delay. - Carver observes, that the skin annually dropped by serpents, though per-7 dry, forms an admirable remedy for drawing thorns, splinters of bones, wood, etc. from the parts thus injured; of which remedy, however, we cannot speak from experience. - When the wound is not inflamed, such extraction may be promoted by enlarging its orifice with a proper instrument; afterwards immersing the limb in tepid water, or repeatedly applying to it a cloth soaked in a similar fluid. But, if any pointed bodies, for instance, pieces of glass, cannot be thus removed, the wounded part should be exposed to the steam of water, and frequent emollient cataplasms be laid over it, with a view to facilitate the ejection of hurtful matters, by means of a speedy suppuration. As soon as the tumor thus treated becomes soft, and presents a yellowish-white spot in its centre, it must be opened; though such favourable change sometimes requires an attentive treatment, for several we
Wounds inflicted by blunt instruments, or by the grazing of a bullet, or by the large and blunt teeth of animals, provided they be not poisonous, should also be treated in the manner already stated ; though it will, in these cases, be useful to apply a pad of folded linen, moistened with sweet-oil, or with a tepid mixture of vinegar and water; because such wounds partake of the nature of bruises. With a view to afford greater security, the parts thus bitten, may preferably be washed with milk, of with luke-warm vinegar and water. LangE, a German surgeon, asserts, that one dram of the pulverized seed of Water-HEMLocK, taken every morning on a piece of bread wou bread and butter, have not only healed malignant bites of animals, but also cured large and fetid ulcers, in an almost incredibly short space of time.
If the shin-bone be wounded, no oil or unguent must be applied; but the injured part should be dressed with a pad dipped in arquebusade or Goulard-water, or vinegar ; either of which ought to be occasionally dropped on the linen, and this suffered to remain undisturbed, in order to exclude the air, and to prevent suppuration. If, nevertheless, inflammation be apprehended, the patient may use, internally, a julep, composed of one pint of water, in which two drams of nitre are previously dissolved, and afterwards 8 oz. of the tincture of roses, 4 oz. of the syrup of pale roses, and 20 drops of vitriolic acid, are successively added : of this mixture he may take two table-spoonfuls every second hour, or oftener; and its operation ought to be supported by cooling purgatives, such as cream of tartar, or any neutral salts. - According to FaudiguieRE, the honey-plaster above mentioned, or the tinder obtained from burnt paper, when applied to a fresh wound, and allowed to remain on the part affected, till it spontaneously fall off, has often proved a very efficacious remedy.
There are many instances on medical record, where small wounds of the veins, in consequence of unskilful blood-letting, have been attended with fatal effects : thus, if a tendon, or cutaneous nerve, be injured, or the orifice in venesection be made too small, the whole arm or leg will become inflamed, and the swelling suddenly spread to the points of the fingers or toes. In these cases, the whole limb ought to be speedily tied up with a proper bandage, and dressed with Goulard or arquebusade - water; and Brambilla recommends emol-lient, anodyne, and antispasmodic remedies to be applied to the wounded part. - There are, however, instances, where the method before suggested would be insufficient to effect a cure. Foubert asserts, that an inflamed arm, in consequence of an injured nerve, by venesection, was successfully treated, " first with corrosive (septic) applications to the part affected, and afterwards with bread-poultices containing Goulard-water, " on the suggestion of Alix. - The celebrated Heister recommends a mixture of oil of turpentine and spirit of wine, to be applied to such. wounded nerves; others advise warm spirituous liquors; and SHER-wen justly praises the efficacy of warm oil of turpentine, which is used by country people, in deep wounds inflicted by a needle, or other pointed instrument, with a view to prevent suppuration : and he observes, that cooling and emollient external remedies are unavailing in those nervous casualties, consequent on blood-letting.
Persons wounded by gun-powder, especially in the face, should not attempt to extract such particles of the powder as may have penetrated through the skin; because they are apt to break, and sink deeper into the muscular fibres : the only application necessary, on these occasions, is Goulard-water, or, more effectually, the ointment composed of oil and lime-water, stated under the article Burns.
With respect to gun-shot wounds, we shall only remark that, according to the experience of the ablest surgeons on the Continent, such
A injuries are always more speedily healed with oil and emollient cataplasms, than with essences, balsams, and other heating drugs. But, as the opinions of professional men greatly differ on this subject, we must refer the curious reader to Mr. John Bell's late publication, entitled " Discourses on the Nature and Cure of Wounds" (8vo. 9s.); and shall add a few remarks of Dr. Robert Jackson, extracted from the 11th vol. of" The London Medical Journal;" where this skilful practitioner expresses himself to the following effect: - The practice of dilating, poulticing, etc. of gunshot wounds, appears to be justifiable only in those cases, where it becomes necessary to extract the ball, or the fragment of a bone ; or in which inflammation is about to commence. In all other instances, Dr. J. considers dilatation as superfluous, and even as contributing to retard the cure : in his opinion, it is sufficient to bind the wound with linen rags, or similar bandage, to prevent the access of air. Cataplasms, says he, may be serviceable in cold climates ; but, in warm countries, bandages moistened with laudanum, or spirituous liquors, and even the affusion of cold water upon wounded limbs, dispose them to heal in a very remarkable manner. He confirms these observations by numerous cases of soldiers who were wounded in the contest with America ; and who recovered more speedily by this treatment, than by adopting the practice of dilatation, and suppuration. - See also the articles Styptic and TOURNiQUET.
Wounds of the joints, such as the knee, foot, etc. heal most expeditiously by the simple application of cold water; provided the orifice of such wounds be immediately contracted by means of adhesive plaster. If they happen to be deep, Schmucker advises blood to be drawn from a vein ; while he observes, that, by renewing the compresses with fresh water, as soon as they become warm, such injuries have generally been cured, without producing inflammation, or any other symptoms. - Foh, on this occasion, recommends the powder of colophony to be strewed on a pledget, which should be moistened with rectified spirit of wine, and thus applied to the injured part; where it will promote the discharge of the glutinous synovia, or the water lubricating the joints. - See also Tendons.
Wounds, in farriery, may be occasioned by various accidents; but, as our prescribed limits do not admit of a minute detail, we shall at present state only the treatment, which may be most advantageously adopted, on common occasions.
In all fresh wounds, occasioned by cutting instruments, it will be sufficient to bring the lips together by ligature, or by suture; after which, rags dipped in brandy should be applied ; or the orifice may be covered with a pledget spread with the following ointment: - Take of Venice turpentine, and bees-wax, each lib.; of olive-oil 1 1/2lb., and 12 oz. of yellow resin: let these ingredients be melted together, and 2 or 3 oz. of finely-pulverized ver-digrease be added; the whole being stirred, till it become cold. - See also vol. ii. p. 482.
In cases of scalds or burns, where the skin remains sound, it will be advisable to bathe the part with camphorated spirit of wine, and to cover it with rags clipped in the same liquor : salt may also be applied wou applied to the burn or scald with considerable efficacy. But, if the skin be once broken, the part affected must be anointed with linseed or sweet-oil, and a plaster, consisting of bees-wax and oil, be laid over it. in consequence of the pain, a slight degree of Fever occur, the animal must be bled, and treated in the manner directed under that article.
The most important, and also the most frequent, of the simple wounds, however, are those of broken knees : this injury is sometimes occasioned by accident, but more commonly by the negligence of grooms; the carelessness of bad riders on rough roads; or, by exhausting the horse's strength through excessive labour. On such unfortunate occasions, the - wounded parts must first be washed with a sponge dipped in warm water, to prevent the inflammation that would otherwise ensue, from the particles of gravel or sand adhering to the flesh : next, they ought to be gently wiped with dry cloths, and bathed with a mixture, consisting of equal parts of camphorated spirit of wine, and vinegar : thus cleansed, they should be covered with a pledget of tow, dipped in the same composition. But, if the wound be so deep, as to produce a considerable degree of inflammation, it will be necessary to promote suppuration, and to treat it in the manner pointed out vol. iii. p. 465. - For the proper management of the more dangerous wounds, the reader will consult the articles Hoof-bony, Hoof-hurt, Over-reach, Punctures, Quit-Tor-bone, etc.