Punctured Wounds.—These wounds are dangerous from their depth, and the internal effusion of serum and blood which usually attend them. In consequence of this, these wounds are frequently followed by severe inflammation and suppuration. These results used to be attempted to be obviated by the practice of dilatation. This, however, is severe practice, and only justifiable in eases of the existence of a foreign body. Setons are recommended by the French surgeons for these wounds, but there are so many objections to them, that they are seldom used by surgeons in this country. Whether these wounds unite by the first or second intention, they require to he healed upon the same general principles as incised and gunshot wounds.
Contused and Lacerated Wounds.—These result from the collision of blunt, obtuse, hard bodies, being forcibly driven against the living tex tures. Although these wounds may occur independent of gunshot. it is in the class of wounds called gunshot that the best examples of lacerated and contused wounds occur. The rapid introduction of powerful machinery into the manufactures of this country renders contused and lacerated wounds of very frequent occurrence in our large towns. In these wounds there is seldom much bleeding, arising from the coats of the arteries becoming twisted and doubled up by the force of their retraction. They are much more liable to have foreign bodies in them than incised wounds. Such wounds seldom unite by the first intention, but in their treatment this object should always be kept in view, as frequently portions of the wound may be induced to unite. During suppuration and granulation, the same plan of treatment should be pursued as when these processes occur in incised wounds. The constitutional symptoms arising from these wounds are generally more severe than from any others, and require attention. Symptomatic fever must be treated according to the same general principles laid down for the treatment of fevers. [FevEns.] Another consequence of these wounds is that dreadful state of the nervous system called tetanus which often resists all kinds of treatment.
Poisoned ll'oun s.—The principal forms of this class of wounds seen in this country arise from the bites of rabid animals, pricks and cuts received in dissection, and the bites of vipers and the stings of insects. The bites of rabid animals are unfortunately too common, and often in this country require the attention of the surgeon. When the poison is introduced into the system, it produces the fearful disease known by the name of hydrophobia, for which medical science has not hitherto found a remedy. [HYDROPHOBIA.] Where persons have been bitten
by eats, dogs, or wolves in a rabid state, the wound should be imme diately excised, and the nitrate of silver (lunar caustic) applied to the wound.
Dissecting Wounds.—Under this head may be included not only the punctures and cuts to which medical men are exposed in the examina tion of the dead human body, but all those wounds after which ill consequences ensue, in which there is reason to suppose some poison generated in an animal organisation has been introduced into the system. It is still sometimes discussed in books on surgery, as to whether the effects following these wounds are produced by a peculiar poison or are only the result of a slight wound in a constitution pre disposed to disease. The frequency of the ill effects of these wounds amongst medical men, as compared with other classes of persons, equally liable to pricking and cutting their fingers, must decide this question in favour of the existence of a poison. It is not, however, as is generally supposed, that putrescent bodies and those advanced in decomposition are most injurious, for it is generally found that the worst consequences follow wounds from recent bodies, especially of persons who die of puerperal peritonitis, The consequences following thee. cute are rine:seine:es and festering of the wounded part, the absorbent glands up the arm become inflamed, there is pain felt in the arm and in the glands of the axills: these symptoms are attended with more or less fever, and generally great anxiety. These symptoms some Gums increase, the cellular tissue of the arm and side becomes inflamed, abscesees form, and the patient sometimes dies from the fever or sub sapient exhaustion. This disease is principally confined to medical nice, and much difference of opinion has existed as to its treatment.
Formerly tonics, wine, and brandy were administered, and active means taken to destroy the poison by caustic potash, liquor ammonite, nitric acid, &c.; but at tho present day there is a general opinion in favour of mild antiphlogistic treatment, and having recourse only to tonics and wine when the symptoms seem to require it. Leeches, bleeding, purgatives, antimonials, end opium constitute the chief features of the treatment in the early and inflammatory stage. The application of lunar caustic, a solution of alum, and other things, have beeu recommended immediately after the receipt of the wound; but, after some considerable experience, it may be doubted if these things prevent the absorption of the poison. At any rate, if any good is to be dime, the application must be immediate.