The rules which we have here given for inducing healing by immediate union or by primary adhesion may, in an emergency, be carried out by any intelligent reader, and ought to be generally known. We do not enter upon the modes of inducing the forms of healing by granulation and by secondary adhesion, as they ought to be carried on under surgical superintendence; nor do we notice the last mode—that of healing under a scab—because it is simply leaving the wound to nature: the most that is required in this case iu the way of auxiliary treatment being to cover the scab with dry cotton-wool, to protect it and the subjacent surface from any causes that may excite inflammation.
Of the other varieties of wounds, it is sufficient to notice the most important points severally peculiar to each variety. Of punctured wounds, the most serious are those which arc made with blunt-pointed instruments, such as nails, pitch-forks, iron spikes, etc., for by these the injured parts are not so divided as that they may retract, but are pressed aside with much bruising, and can close again as soon as the instrument is with drawn; and in this lies the chief danger of these wounds, because blood or other fluids are likely to extravasate into them, and cannot readily escape. These fluids, by decom posing or by mere pressure, may excite inflammation, and thus cause deep and con firmed suppuration, and great destruction of tissues. Some of the worst forms of these wounds are those produced by sharp teeth, probably (as Mr. Paget suggests) because of the force with which, as they tend to meet, the teeth crush the intervening parts. In contused wounds, the great question is whether their union should or should not be attempted. If union is to be attempted, the rules given for the treatment of incised wounds must be followed, especial attention being paid to their careful cleaning, the removal of clots of blood, and their warm covering with acme soft material, as cotton wool. When it would be useless, from the extent of the bruises, etc., to attempt union,
the following rules, as laid down by Mr. Paget, should be adopted: "The pint should be kept at rest, and as nearly as possible at its natural temperature. For the latter pur pose, and for protection, an excellent dressing is lint or cotton-wool thoroughly soaked .113 olive 6d, and completely fitted to the part. Dry cotton-wool may be applied over this, or oiled silk. Water-dressing may ho similarly applied; or warm poultices, but they are generally less comfortable. Irrigation is, in some cases, very soothing, espe cially in ragged wounds, but it should be with tepid water. The methods of the dress ing, after the first, may be almost the same as for incised wounds."—Op. tit. p. 598. The treatment of lacerated wounds is almost precisely the same as that of contused wounds. poisonous wounds are sufficiently discussed in the article BITES; and there is a special article on Gr TN-SHOT Wouims, which are, in reality, only an im portant variety of contused wounds.
In conclusion, it must be mentioned that various kinds of wounds are liable to cer tain complications, of which some are local, and others general or constitutional. Among the former arc recrr.ing or secondary bleeding, pain, spasmodic muscular movements, and the presener fd foreign bodies; while the latter include defect or excess of reaction, traumatic deliriu;L., fever, erysipelas, pyremia, etc. Some of these eompli cat.ous are treated of in special articles of this work; and for the treatment of the remainder, we must refer to Mr. Paget's memoir, from which most of the details of the present article are borrowed.