An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![Brush Buhx.—By tliis term is meant a peculiar form of siiperfieial lace- rated and contused wound caused by friction applied to the surface of the body, as when a portion of skin is brouujht into contact with a rapidly-nioving belt of machinery, or by an involuntary slide down a steep incline, or by the slip- ping of a rope through the closed hand. In this injury the superficial tissiies are ground off and an eschar of considerable depth results. They should be treated by antiseptic fomentations until the eschar has separated and a granu- lating surface has formed, which should then receive the treatment elsewhere described. PUNCTURED WOUNDS. Deeply perforating wounds made by pointed substances will partake of the nature of either incised or contused and lacerated wounds, according to the sharpness of the point of the wounding instrument. Punctured wounds made with sharp, clean-pointed instruments, as pins, needles, trocars, dagger and stiletto points, partake of the nature of limited incised wounds, and unless in their course they have wounded organs of im])ortance, as large blood-ves- sels or nerves, the Avithdrawal of the instrument is followed by rapid and per- fect recovery. Should the puncturing instrument, however, be contaminated with active septic material, an acute septic inflammation will result, depending upon its depth from the surface for its importance, and demanding free incisions for the relief of the pent-up secretions. For its further care those measures which have been described as required for inflamed and infected incised wounds will be indicated. Punctured wounds which are formed by the thrusting into the tissues of irregularly-shaped and blunt substances, such as splinters of wood, nails, a bayonet, and the like, form deep and narrow wound-tracks, the walls of which are contused and lacerated, Avhile minute fragments of devitalized tissues or small fragments of infected material are driven in and deposited in the depths of the wound. The dangers and difficulties attending ordinary contused and lacerated wounds are aggravated in these cases by the long and narrow track which leads from their bottom to the surface. Should no septic material have been introduced by the wounding body, such wounds may yet be expected to heal kindly and promptly if care is taken to avoid their subsequent infection from Avithout and to keep the wounded part at rest while repair is taking place. In view of the impossibility of ade([uately disin- fecting such a wound by mere applications to the surface at the time of the dress- ing, as a general rule it should be freely laid open to the bottom by additional incisions, and there should be thorough disinfection of the wound and the adjacent integument. It should then be covered with an abundant antiseptic dressing, which should be supplemented by any posture or by the application of whatever apparatus that may be required to keep the part at rest. If, notwithstanding this, inflammation of the deeper part of the wound develo))s, immediate resort should be had to suitable free incisions to give vent to pent-up eflusions and for subsequent disinfection and drainage. The more deep and narrow the wound- track, the more important that free and early incisions should be made. Still more important, if possible, are such early incisions when the puncture has involved strong fasciae, the thecfe of tendons, or joint-cavities. Delay in resort- ing to such incisions is not only sure to produce extensive local damage, but may even prove dangerous to life. Not infrequently portions of puncturing bodies are broken off and left imbedded in the tissues. In some cases such imbedded substances may remain innocuous for an indefinite period of time. In yet other instances their presence provokes irritative symptoms of a marked character. Foreign](https://iiif.wellcomecollection.org/image/b21217014_0148.jp2/full/800%2C/0/default.jpg)
