When abscesses have formed in the neighbourhood, the
cavities should be freely exposed by incision; thus a free discharge
will be given to the matter, and the cavity brought to granulate from
the bottom. During the suppurating stage, the patient’s strength must
be maintained by generous diet.
Punctured wounds are dangerous, from the deep and internal effusion of
blood and serum which usually attends them. The effusion, which in open
wounds is poured out externally, and moderates and prevents the excited
action from exceeding what is salutary, is, in punctured wounds, poured
into the substance of the limb to its detriment. It is followed by
severe inflammatory action and profuse suppuration. In order to prevent
these untoward results, it was formerly the practice immediately to
dilate the wound; but this is hurtful, for if the wound be deep, as it
generally is, dilatation of its whole extent is a proceeding severe in
itself, and in its consequences; whilst, if the external part only of
the wound is dilated, the operation will entirely fail to effect what
is intended. The knife will be used in great good time where a foreign
body is found to be lodged in the wound, when tension has occurred, or
matter has formed. Sometimes the wound heals throughout its whole track
by adhesion, without any bad symptoms being so much as threatened.
Setons, recommended in this class of wounds, are of no service. It is
not the narrowness of the external opening, as is sometimes supposed,
that is the cause of all the mischief, but the injury and consequent
inflammation of deep-seated parts.
Public-domain text, read in full here on John Shaqi.
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