Volume 1

A treatise on surgery / by George Ryerson Fowler.

  • George Ryerson Fowler
Date:
1906
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on surgery / by George Ryerson Fowler. Source: Wellcome Collection.

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    the foreign body enters and emerges. If some specific poison has been car¬ ried into the wound and has infected it, it is then spoken of as a poisoned wound. Wounds are likewise said to be septic or aseptic, according as they have been infected or not with those organisms which excite putrefaction or other disorganization of tissue. Destruction of tissue to a greater or lesser extent characterizes all wounds. Symptoms.—A symptom common to all wounds is separation and gaping of its edges. This is caused by the presence of elastic fibers in the connective tissue and cutis, and emphasizes the elasticity characteristic of the uninjured skin. The degree of gaping depends on the number and direction of the elastic fibers, as well as on the depth of the wound. If the wound separates the tissues in a direction parallel to that of the elastic fibers, the gaping will be less than when these are separated in a transverse direction. Deep wounds gape more than superficial ones. The hemorrhage which accompanies a wound depends on the depth, length, and breadth of the wound, as well as on the size and condition of the divided blood-vessels. As a rule, this symptom is less marked in contused and lacerated wounds than in those with clean-cut and sharply defined edges. The symptom of pain is usually an immediate accompaniment of a wound, and results from the injury and irritation of the numerous fibers of sensory nerves in the injured tissues. It is of a sharp, burning character and radiates along the nerve-trunk or in the area of its distribution. The more rapidly and thoroughly the nerve-fibers are divided, the less, as a rule, is the pain. It may happen that no pain whatever is experienced, owing to the rapidity with which the wound is inflicted, or to mental excitement at the time of the injury. In clean incised wounds the wounded person may not be aware that he is injured until his attention is attracted by the presence of blood. Contused wounds are the most painful of injuries. Individual temperament also may modify the amount of pain. Courageous persons and those in a furious rage, on the one hand, and those exercising a quiet self-control, on the other, suffer the least, for these conditions act as restraining influences on the sensory cortical centers. Healing by Primary Intention, i.e., without Suppuration.—Wounds with sharply defined edges and but slight separation may heal in a relatively short time, no essential change being discoverable in the wound and its sur¬ roundings. A very narrow blood-coagulum fills the interspace and causes agglutination of its edges, while the upper layers of this coagulum projecting just beyond the edges become dried and form a thin line or scab, hermetically sealing the wound. In the earlier stage of this reparative process the wound may be reopened by very slight violence, but as organization takes place in the thin cement of blood-clot, union becomes firmer, until finally the narrow surface scab falls off, leaving a bluish or purple furrow covered with new and tender epidermis—the cicatrix. The period of time occupied by the healing process varies with the degree of separation of the edges of the original wound. Small incised and punctured wounds that have not been exposed to irritating or septic influences may heal in the course of twenty-four hours. As a rule, however, from five to seven days are required before the falling of the crust announces the completion of the healing process. Even considerable losses of substance in the skin, particularly if extending only to the rete Malpighii, may be completely repaired in a very short time;
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