WOUNDS may be defined to be divisions of soft parts produced by external mechani cal force. They have been classified by surgical writers in various ways, but the most useful arrangement is that which is adopted by Mr. Paget, in his admirable memoir on " Wounds,' in Holmes's System of Surgery, and is based on their mode of infliction. They are thus divided, first, into open and subcutaneous wounds: the former including those in which the outer part of the wound is almost or quite as extensive•as the deeper Dart • and the latter, all those in which the outer part of the wound is very much smaller than the deeper part. These wounds (especially those of the first kind) may be further divided into (1) incised wounds, such as cuts or incisions, including those which remove a portion of the body; (2) punctured wounds, such as stabs; (3) contused wounds, in which the divided parts are bruised or crushed; (4) lacerated wounds, in which there is tearing of the tissues; (5) poisoned wounds, in which some poison or venom is inserted; and to these may be added, as a special variety, (6) gunshot wounds.
Simple, open, incised wounds will be more fully noticed than any of the others, because they have been most fully studied, and in their surgical relations are the most impor tant. In a clean cut, whether made accidentally or in a surgical operation, three things are chiefly to be observed—viz., the opening or gaping by the retraction of their edges, the bleeding, and the pain. The gaping of a wound is caused by the retraction of the various tissues which are divided. Of the various tissues, the skin exhibits the greatest degree of retraction, and then (in the order in which they stand) elastic tissue, cellular or connective tissue, arteries, muscles, fibrous tissues, nerves, and cartilages. In addition to the immediate gaping of fresh wounds, many wounds, if they be not prevented, will continue to retract for a long time. For example, in stumps that heal slowly, the limb terminates in a cone, in consequence of the prolonged retraction of the muscles. The bleeding from an incised wound depends chiefly on the size and number of the divided vessels, and on their connection with the surrounding parts, but to a certain extent on the previous condition of the wounded part, or on the peculiar constitution of the patient. Gradually, with or without surgical help, the vessels cease to bleed; and then, if the wound be left open, there is an oozing of blood-tinged serous fluid, succeeded gradually by a paler fluid, which collects like a whitish film on the surface, and contains an abundance of white or colorless blood-cells, imbedded in a fibrinous (and therefore spontaneously coagulating) fluid. The nature of the pain cannot be made clear by any
description to those who have not felt it; and it is more than probable that a similar wound inflicted on two or three persons would occasion different degrees of pain in each. There are also differences, as Mr. Paget has pointed out, " in both the kind and degree of pain, according to the place and manner of the wound. Thus, in regard to the skin, wounds of the face and of the extremities of the fingers and toes, seem to be among the most painful; those of the back among the least so; and wounds cut from within are less painful than those from without. The skin appears far more sensitive to wounds than any of the deeper structures, except the nerves of sensation themselves; but any part (at periosteum or tendons) may become, by disease or distention, highly sensitive." cit., p. 581. The local consequences of an incised wound are indicative of inflam mation. In the course of an hour or more, the edges of the wound and the adjacent parts become swollen and abnormally sensitive, feel hot and aching; the sutures (if any have been inserted) become tighter, and the edges and intervening spaces gape in conse quence of the swelling. These symptoms gradually subside in two or at least four days, unless there is some abiding source of irritation. Except in very severe wounds, no general consequences are apparent. In those exceptional cases, as in amputations, for example, a shock and subsequent reaction (both of which arc described in the article &men) are observed. The duration of this feverish reaction or traumatic fever does not seem to hear any fixed relation to the severity of the injury. Sometimes it subsides within 24 hours; more often, after h. :go wounds, it does not subside for three or four days, when the pulse and breathing grad :ally return to their natural standard, and the skin becomes soft and cool. The beginning of suppuration coincides with the subsidence of the fever. If the fever should last more than four or five days after the receipt of the injury, there is probably some persistent irritation or some morbid com plication.