WOUND, in surgery, a solution of contin uity of any tissue or soft part of the body. Wounds are divided liv writers on sitmery into several kinds, the distinctions being founded either upon the sort of weapon with which the injury has been inflicted; upon the circumstance of a scnomous matter having been introduced into the part; or upon the nature of the wounded parts themselves, and the particular situation of the wound. Hence we have cuts, incisions, or incised wounds, which are pro duced by sharp-edged instruments, and are gen erally free from all contusion and laceration. The fibres and texture of the wounded part have suffered no other injury but their mere division; and there is, consequently, less tend ency to inflammation, suppuration, gangrene and other bad consequences than in the gener ality of other species of wounds. Another class of wounds are stabs or punctured wounds, made by the thrusts of pointed weapons, as bayonets, lances, swords, daggers, etc., and also by the accidental and forcible introduction of con siderable thorns, nails, etc., into the flesh. These wounds frequently penetrate to a great depth so as to injure large blood-vessels, viscera and other organs of importance; and as they are generally inflicted with much violence the parts suffer more injury than would result from their simple division. Many instruments by which punctured wounds are made increase in diam eter from the point, and when they penetrate far they force the fibres asunder like a wedge, and cause serious stretching and contusion. Bayonet wounds of the sery soft parts are ordinarily followed by violent inflammation, tumefaction, large abscesses, fever, delirium, etc. A third description of wounds are the contused and lacerated, which strictly compre hend, together with a variety of cases produced by the violent application of hard, blunt, obtuse bodies to the soft parts, all those common In juries called gunshot wounds (q.v.). Many bites rank also as contused and lacerated wounds. In short, every solution of continuity which is suddenly produced in the soft parts by a blunt instrument or weapon which had neither a sharp point nor edge must he a contused, lacerated wound.
Poison wounds are those which are compli cated with the introduction of a venomous mat ter or fluid into the part. Such are the stings and bites of a variety of insects, and the sun goon, in the dissection of putrid bodies, or in handling instruments infected with any venom ous matter, is exposed to the danger of poisoned wounds from cuts. The most dangerous, how ever, of this class of wounds occur from the bites of the viper, the rattlesnake, etc., or from those of rabid animals. (See HYDROPHOBIA). Wounds may likewise be universally referred to two other general classes, the simple and com plicated. A wound is called simple when it occurs in a healthy subject, has been produced by a clean, sharp-edged instrument, and is un attended with any serious symptoms. A wound,
on the contrary, is said to be complicated when the state of the system, of the wounded part, or the wound itself, indicates the necessity for more complex treatment than the simple reunion of the cut surfaces. The differences of compli cated wounds must, therefore, be very numer ous. as they depend upon many incidental cir cumstances, the principal of which, however, are hemoirhage, orrvolls syMptOMs, contusion. the unfavorable shape of the injury, the dis charge or extras asation of certain fluids, indi cating the injury of particular bowels or'vessels, etc. All large or deep wounds arc attended with more or less symptomatic fever, which usually comes on at a period varying from 16 to 36 hours after the infliction of the injury, and is generally of the inflammatory, but sometimes of an asthenic character. The liability to gan grene is also a formidable danger to be guarded against in the treatment of complex wounds.
In incised wounds the first thing to be at tended to is to stop the hemorrhage. This is usually accomplished by simply bringing the edges of the wound together; but if any of the larger blood-vessels have been injured, pressing the trunk by means of a bandage or tourniquet will be necessary; and should this not succeed, the vessels must be secured with ligatures. Next, care should be taken that all extraneous substances are remiss ed from the wound. Then the edges of the wound are to be brought to gether, and retained either by straps of ad hesive plaster, or in some situations by one or two stitches. Generally such wounds heal very quickly, without any suppuration, by first in tention.* When, however, this is not the case, and suppuration comes on, all attempts to pro cure union by first intention should be aban doned, the plasters and bandages removed, poul tices and warm dressings used to remove in ilammation, and afterward healing ointment applied. Lacerated and contused wounds re quire to be similarly treated; but they heal less kindly, and suppuration almost always takes place. The swelling and inflammatory s toms which commonly attend contused wounds are to be diminished by cooling lotions or emol lient poultices. Punctured wounds are danger ous from their depth; and the internal effusion of serum and blood which usually attends them. They are frequently also followed by severe inflammation and suppuration. The same gen eral principles apply in this case, too. Some times it may be necessary to enlarge the wound a little, so as to remove the stretching of the parts, and to lessen the inflammation; leeches and fomentation are often required. In poi soned wounds free incisions, and even ampu tation may often be necessary. See GUNSHOT WOUNDS and consult Brewer, G. E., 'A Text book of Surgery' (New York 1915); Groves, E. NV. H., 'Gunshot Injuries of Bones' (Lon don 1915); Pcnhollow, D. P., 'Military Sur gery' (ib. 1916); Stevenson, W. F., 'Wounds in War' (New York 1898).