Such kind of wounds, however, are not without danger; the patient is
not only very liable to be seized with such a fever as I have spoken of
§ XXIII. but he also runs a risque from the wound itself. It is true,
that these two dangers, that attending the fever, and that from the
wound, which I shall mention by and bye, are connected, and generally
accompany each other. It sometimes happens of a sudden, and without
the patient, or the physicians and surgeons having any suspicion of
it, that the wounds dry up, become corrupted, and exhale an infectious
stench; the neighbouring parts are very much inflamed for some days,
after which the inflammation goes off, leaving a kind of œdematous
tumour, which produces an abscess, with a laudable discharge, or
degenerates into a malignant sore, without any abscess. Sometimes these
sores are beset with swarms of maggots.
The treatment of the fever is the same I have described § XXIII. that
of the wound, in this troublesome situation, ought to be to endeavour
intirely to remove the inflammation, which readily terminates in
suppuration, and forms large cavities full of matter, which must be
opened.
A moderate compression of the neighbouring parts, in this case, as in
those I have already mentioned, contributes to prevent the reabsorption
of the purulent matter. If the inflammation runs high, and the patient
is young, it should be moderated by bleeding, and other medicines
calculated to check and resolve the inflammatory denseness of the
blood[26].
If the cause of the inflammation be obvious, it must be removed; thus
every pointed splinter of a bone must be separated with a knife or saw;
whatever occasions a compression must be taken away, and if there be
any fibrous part causing too great a stricture, it must be cut through,
dilating the wound by incisions of a convenient depth.
The dryness and putrefaction of the wound, may be remedied by dressing
it with the powder composed of sal ammoniac and camphor, mentioned §
X. and by moistening it afterwards with oil of turpentine; or, I cause
the wounds, both the original ones, and those made by the surgeon, to
be dressed with pledgets, dipt in a balsam composed of _four ounces
spirit of wine, half an ounce spirit of turpentine, and three drams
spirit of sal ammoniac_: Afterwards, having first applied the dressings
very thin, the parts must be constantly fomented with some of the
compositions mentioned § XXI.
The maggots may be destroyed, by frequently shifting the bandages,
linnen, cloaths, and coverings of the bed; by the application of the
balsams I have already spoken of, which destroy these insects and
prevent putrefaction; by constantly keeping on the bed-clothes, a
linnen cloth dipt in tincture of aloes or vitriol. But care must be
taken that the tincture of aloes does not touch the affected limb,
much less the sores themselves, lest part of it should be absorbed,
and occasion a diarrhæa; although in other respects aloes powerfully
resists putrefaction, and is sometimes a useful vulnerary.