WOUND, a solution in the continuity of the soft parts of the body. Contused wounds, or bruises, are injuries to the cellular tissues in which the skin is not broken. In parts where the tissues are lax the signs of swelling and discoloration are more noticeable than in the tenser tissues. The discoloration is caused by haemor rhage into the tissues (ecchyrnosis), and passes from dark purple through green to yellow before it disappears. If a considerable amount of blood is poured forth into the injured tissues it is termed a /iaematoma. The treatment of a bruise consists in the application of cold lotion, preferably an evaporating spirit-lotion, to limit the subcutaneous bleeding. The haemorrhage usually be comes absorbed of its own accord even in haematomata, but should suppuration threaten an incision must be made and the cavity aseptically evacuated.
Open wounds are divided into incised, lacerated, punctured and gunshot wounds. Incised wounds are made by any sharp instru ment and have their edges evenly cut. In these wounds there is usually free haemorrhage, as the vessels are cleanly divided.
Lacerated wounds are those in which the edges of the wound are torn irregularly. Such injuries occur frequently from accidents with machinery or blunt instruments, or from bites by animals. The haemorrhage is less than from incised wounds, and the edges may be bruised. Punctured wounds are those in which the depth is greater than the external opening. They are generally produced by sharp-pointed instruments. The chief danger arises from puncture of large blood-vessels, or injury to important structures such as those in the thorax and abdomen. The great danger of all open wounds is that pathogenic micro-organisms will be intro duced at the time of injury.
The treatment of incised wounds is to arrest the bleeding (see HAEMORRHAGE), cleanse the wound and its surroundings, removing all foreign bodies (splinters, glass, etc.), and obtain apposition of the cut surfaces. This is usually done by means of sutures or stitches of silk, catgut, silkwormgut or silver wire. If the wound can be rendered aseptic, incised wounds usually heal by first in tention. In lacerated wounds there is danger of suppuration, sloughing, erysipelas, while if soil, particularly cultivated and heavily manured soil, be carried into the tissues during the in jury there is risk of gas-gangrene, malignant oedema or tetanus. These wounds do not heal by first intention, and there is conse quently considerable scarring. The exact amount of time occu pied in the repair depends upon the presence or not of septic material, as lacerated wounds are very difficult to cleanse properly.
Carbolic acid lotion should be used for cleansing, while torn or ragged portions should be cut away and provision made for free drainage. It is not always possible to apply sutures at first, but the wound may be packed with antiseptic gauze, and later, when a clean granulating surface has been obtained, skin-graft ing may be required. In extensive lacerated wounds, especially in conjunction with comminuted fractures, amputation of a limb may be called for. Punctured wounds should be syringed with carbolic lotion, and all splinters and foreign bodies removed. The location of needles and other bodies opaque to the rays is facili tated by the use of the Röntgen rays ; the wound can then be packed with gauze and drained. If a large vessel should have been injured, the wound may have to be laid open and the bleeding vessel secured. Should paralysis indicate that a large nerve has been divided, the wound must also be laid open in order to suture the injured structure.
It is only possible here to mention some of the special character istics of gunshot wounds. A remarkable collection, largely added to during the World War, is contained in the Museum of the Royal College of Surgeons of England and smaller collections are to be found in some other great centres. With the modern small-bore rifle of high velocity, machine guns and Lewis guns the aperture of entry is small and the aperture of exit larger and more slit like. There is usually but little haemorrhage. Should no large vessel be torn, and should no portion of septic clothing be carried in, the wound may heal by first intention. Such bullets may be said to disable without killing. They may drill a clean hole in a bone without a fracture, but sometimes there is much splintering. Abdominal wounds may be so small that the intestine may be penetrated and adhesions of neighbouring coils of intestine cover the aperture. Martini-Henry bullets make larger apertures, while soft-nosed or "dum-dum" bullets spread out as soon as the bullet strikes, causing great mutilation and destruction of the tissues. Shell wounds cause extensive lacerations. Small shot may inflict serious injury should one of the pellets enter the eye. In gunshot wounds at short distance the skin may be blackened owing to the particles of carbon lodging in it. The chief dangers of gun shot wounds are haemorrhage, shock and the carrying in of septic material or clothing into the wound.