Wounds

:WOUNDS. The treatment of wounds, says the late Dr. Dadd, depends altogether upon their nature and cause. It is very difficult in the horse—although not so in man—to heal a wound by what is called first intention, which means union by medium of coagulable lymph without suppuration. The definition of wound, technic ally, is, a solution of continuity in the soft parts, produced by some mechanical agent. Wounds are divided into incised, contused, lacerated, punctured, and penetrating, of these our author ity says:. Incised wounds are those inflicted by sharp instruments. On the human body they often heal without any subsequent inflammation, beyond what nature sets up in the restorative process; but the difficulty in the horse is, that we can not always keep the parts in contact, and therefore it is not so easy to unite them. In many cases, after having been at the trouble to adjust by sutures the edges of divided parts, and when all seems going ou favorably, the animal gets his head round, and tears the wound open afresh, so that our labor is all in vain. This puts a damper on healing by first intention. There are several other difficulties in the way of healing by this method, well known to anatomists. We shall just merely refer to the principal one, because it may satisfy the reader that some wounds had better not be sutured, for they put the subject to a great deal of pain for no pur pose. Horses, as well as some other animals, have, in lieu of hands, a peculiar muscular arrangement under the skin, by means of which they can shake off flies and other foreign bodies; and it is owing to the facility with which they can jerk or move the skin that we often fail in uniting flesh wounds. Other obstacles are to be met with, both in relation to the size of the wound and as regards its anatomical direction. If the wound is seen immediately after infliction, , and there seems to be the least probability of healing by first intention, we place a twitch on the horse's nose, and examine the part. If there be found neither dirt nor foreign body of any kind, the blood had better not be washed off; for this is the best healing material in the world. The edges are then to be brought together by interrupted sutures, taking care not to include the ,hair between the edges of the wound, for that would effectually prevent union. Nothing more is needed but to secure the animal so that he can not get at it. If he is to be kept in the stable, without exercise, for any length of time, he had better be put on half diet. Pure air will not hurt him. Contused wounds are generally occasioned by hooks, or some blunt body connected with the harness or vehicle. They generally leave a gaping wound with bruised edges. We have only to remember that nature possesses the power of repairing injuries of this kind—of filling up the parts and covering them with new skin• all we have to do is, to attend to the general health of the animal, and keep the wound in a healthy condition. A usual applica tion and a good one, is the compound tincture of myrrh. If the part assume an unhealthy aspect, a charcoal poultice will rectify that. If such can not be applied, owing to the situation of the wound, dress it with pyroligneous acid. Lac erated wounds are generally in the form of a rent • rather than cut, inflicted by the calking of a shoe tearing off the integuments and subcellular tissue, leaving a sort of triangular flap. In these cures we generally employ sutures, and treat them the same as incised wounds. Punctured wounds are those inflicted by a pointed body, as a nail in the foot, point of a fork, or splinter of wood. These are the most dangerous kinds of wounds, for they are frequently the cause of fistula and locked jaw. We make it au invariable rule, in the treat ment of punctured wounds, to first examine by probe or otherwise, and remove any foreign body that may be present, and then poultice with flax seed, into which we stir a small quantity of fir balsam. In puncture of the foot by nail, instead of plastering it with tar, and forcing a tent into the orifice, and then covering the sole with leather, as most baeksmiths are wont to do, we have the shoe taken off, the foot washed clean, and a moderately w'arm poultice applied, and renewed daily, until the suppurative stage commences. That once established, we consider our patient safe; for Many men, as well as animals, have lost their lives from the absorption of pus formed in the wound after the external breach had healed. When a bone is injured by the point of a nail, or fork, the cure is rather tedious; the primary means, however, are the same. The poultices may be followed by astringent injections as alum water, etc. In case of injury to the bone, we use pyroligneous acid; to be thrown into the wound by means of a small syringe. If exten sive disease of the bone sets in, the services of a veterinary surgeon will be required. A very pro fuse or unhealthy discharge from a punctured wound must be met by constitutional remedies. Sulphur and sassafras, to the amount of half an ounce each, every other day, to the amount of three or four doses, will arrest the morbid phenomenon. The local remedy in all cases of this kind is diluted acetic or pyroligneous acid. Penetrating wounds are inflicted by the horns of cattle, stakes, shafts, etc., and have to be treated according to the nature of the case. A pene trating wound of the walls of the abdomen is generally followed by protusion of the intestines; this has to be returned; the wound is then closed by strong sutures, and the belly must be encir cled with a long bandage. In such cases we

generally keep the bowels soluble with scalded shorts, well seasoned with salt, and empty the rectum occasionally 'by enema. Of penetrating wounds of intestines, to illustrate the mode of procedure when they are wounded, the following case is introduced: The animal had a wound on the off side, about four inches in length, in the iliac region, through which a portion of the small intestine protruded. On exploring the breach, it was found to run in a slanting direc tion, and as it approached the peritoneum, was found quite small, scarcely admitting the little finger; here the bowel was both strangulated and lacerated, the intestinal opening being external to the stricture. Before proceeding to cast the horse, a twitch was placed on the nose, and the edges of the wounded intestine were neatly sewed together with a very fine suture needle. Our reason for doing this before casting was, lest in the animal's struggles the bowel might recede, and give us some trouble in getting hold of it again. There was not much danger of it, how ever; still we wanted to be on the safe side. The intestinal wound was not produced by the cow's horn, but took place some three hours afterwards, and two hours before we saw the case, in the fol lowing manner: the protruded bowel had then become distended with • gas, and according to the owner's acceunt, was about the size of his two fists. The animal, probably being in pain, got down and rolled on the injured side, and thus burst the gut. After sewing up the wounded intestine, it was cleansed with warm water, and attempts were made to return it within the abdomen, but to no purpose. The patient was then cast, and, by means of a bundle of straw, on each side, propped him on his back; the bowel did not return so easily as we had expected, for it was found necessary to dilate the stricture by means of a button-pointed bia toury. The several layers of abdominal muscles were then sutured with as much nicety as the nature of the wound admitted; and lastly the integuments were brought together by inter rupted suture. This case terminated unfavor ably, for the animal died on the sixth day from peritonitis. It may be well to observe that the accident happened on a very cold day, in the depth of winter; and the being so long exposed to the depressing influence of probably led to the fatal result; for it is well known that operations of this kind often prove successful. It may be interesting to the reader to know that wounds of the intestines heal as readily as those of other parts, as the following k, cases will show : An incision one inch and a half in length was made in the bowels of a dog; the wound of the integuments was closed by suture; the animal was scarcely affected by the operation, took food as usual, and had natural evacuations. At the end of a fortnight, when perfectly recovered, he was killed for the pur pose of examining the bowel, when the wound appeared to be completely healed. In the eighteenth volume of the Philosophical Transac tions a similar experiment is related by Mr. W. Cooper: An opening was made in the abdomen of a dog; a large wound was made in the intes tines, and the wound in the abdomen was stitched up, etc. ; the dog recovered without any bad symptoms, and became perfectly well in a few days after. It should be observed that the bowel does not appear to have been stitched up • when returned into the belly. The following experiment by Mr. Travers is still more remark able: A ligature of thin packthread was firmly tied round the first intestine (duodenum) of a dog so as completely to obstruct it; the ends of• the string were cut off, and the parts returned; the wound in the abdomen was closed, and the ani mal expressed no sign of suffering when the operation was concluded. On the following day he was frequently sick, and vomited some milk that was given him; his respiration was hurried. Third day his sickness continued, and he vomited some bilious fluid. Fifth day he passed a copi ous 'Stool of the same appearance as the fluid discharged by vomiting; his sickness from this time ceased, and his breathing was natural; he took bread and milk, and drank abundantly of water. Seventh day he had three similar evacu ations, and appeared well, eating animal food freely. On the fifteenth day, his cure being established, lie was killed for the purpose of examination. The ligature which was fastened around the intestine divided the interior coats of the gut, in this respect resembling the operation of a ligature upon an artery; the peritoneal or outer coat alone maintained its integrity. The inflammation which the ligature induces on either side of it is terminated by the deposition of a coat of lymph, exterior to the ligature; this quickly becomes organized; and the ligature, thus enclosed, is liberated by the ulcerative pro cess, falls of necessity into the canal, and passes off by stool. Penetrating wounds of the chest are not fatal, provided the lungs or heart are not perforated. All that can be done is to suture the wound, pass several turns of a roller round the chest, and adopt such constitutional means as the case seems to require.