city; and so frequently employed the knife, hot irons, and other cruel methods of cure, that he was branded with the opprobrious title of carnifex, and expelled the city, where no physician or surgeon of eminence again made his appearance for 180 years. At this time Asclepiades under took the profession of medicine; but seems to have dealt little in surgery. Neither have we any thing of importance on that subject till the time of Celsus, who flourished during the reigns of Augustus and Tiberius. In his surgery, all the improvements from Hippocrates to his own days are collected; the most minute and trifling diseases are not omitted. An eminent surgeon of the moderns emphatically exhorts every person in that profession" to keep Celsus in his hands by day and by night." He describes the signs of a fractured skull, the method of examining for the fracture, of laying the skull bare by an incision in the form of the letter X, and afterwards of cutting away the angles, and of applying the trepan, with the signs of danger and of recovery. He observed that sometimes, though very rarely, a fatal concussion of the brain might happen, the blood-vessels within the skull being burst, yet the bone remaining entire. After the operation of the trepan, sponges and cloths wetted with vinegar, and several other applications, were made to the head; and, throughout, severe abstinence was enjoined. In violent fractures of the ribs, he ordered venesection; low diet; to guard against all agitation of the mind, loud speaking, motion, and every thing that might excite coughing or sneezing. Cloths wetted with wine, roses and oil, and other applications, were laid over the fracture. The cure of fractures, in the upper and lower extremities, he said, were nearly alike; that fractures differ in degree of violence and danger, in being simple or compound, that is, with or without a wound of the flesh, and in being near to the joint. He directs the extension of the member by assistants; the reduction, by the surgeon's hands, of the fractured bones into their natural situation; and to bind the fractured part with bandages of different lengths, previously dipped in wine and oil: on the third day fresh bandages are to be applied, and the fractured member fomented with warm vapour, especially during the inflammation. Splints, if necessary, are to be applied, to retain the bones in a fixed position. The fractured arm is to be suspended in a broad sling hung round the neck: the fractured leg is to be inclosed in a kind of case, reaching above the ham, and accommodated likewise with a support to the foot, and with straps at the side, to keep the leg steady in the fractured thigh-bone, the case is to extend from the top of the hip to the foot. He describes the method of treating compound fractures, and of removing small fragments of splinters of bones; and the manner of extracting darts. In luxations of the shoulder, he mentions several methods of giving force to the extension, and of replacing the dislocated bone. One method similar to that of Hippocrates was, to suspend the patient by the arm; the fore-part of the shoulder, at the same time, resting upon the top of a door, or any other such firm fulcrum. Another method was to lay the patient supine, some assistants retaining the body in a fixed position, and others extending the arm in the contrary direction; the surgeon, in the mean time, attempting, by his hands, forcibly to reduce the bons into its former place. If a large inflammation were expected to ensue after a wound, it was suffered to bleed for some time, and blood was drawn from the arm. To wounds accompanied with considerable hæmorrhagy, he applied a sponge wet in vinegar, and constant pressure: if necessary, on account of the violence of the hæmorrhagy, ligatures were made round the vessels, and sometimes the bleeding orifice was seared up with the point of a hot iron. On the third day fresh dressings were applied. In considerable contusions, with a small wound of the flesh, if neither blood-vessels nor nerves prevented, the wound was to be enlarged. Abstinence and low diet, upon all such accidents, were prescribed; cloths wet with vinegar, and several other applications, were to be applied to the inflamed part. He observes, that fresh wounds may be healed without compound applications. In external gangrene, he cut into the sound flesh; and when the disease, in spite of every effort, spread, he advised amputation of the member. After cutting to the bone, the flesh was then separated from it, and drawn back, in order to save as much flesh as possible to cover the extremity of the bone. Celsus, though extremely diffuse in the description of surgical discases, and of various remedies and external applications, treats slightly of the method of amputating; from which, comparing his treatise with the modern systems, we might infer that the operation was then seldomer practised than at present. He describes the symptoms of that dangerous inflammation the carbuncle, and directs immediately to burn, or to corrode the gangrened part. To promote the suppuration of abscesses, he orders poultices of barley-meal, or of marsh-mallows, or the seeds of linseed and fenugreek. He also mentions the compositions of several repellent cataplasms. In the erysipelas, he applies ceruse, mixed with the juice of nightshade; and sal-ammoniac was sometimes mixed with his plasters. He is very minute in describing diseases of the eyes, ears, and teeth, and in prescribing a maltitude of remedies and applications. In inflammation of the eyes, he enjoined abstinence and low diet, rest, and a dark room: if the infiam. mation was violent, with great pain, he ordered venesection, and a purgative; a small poultice of fine flour, saffron, and the white of an egg, to be laid to the forehead to suppress the flow of pituita; the soft inside of warm wheat-bread dipped in wine, to be laid to the eye; poppy and roses were also added to his collyriums, and various ingredients too tedious to enumerate. In chronic watery defluxions of the eyes, he applied astringents, cupped the temples, and burnt the veins over the temple and forehead. He couched cataracts by depressing the crystalline lens to the bottom of the orbit. Teeth loosened by any accident, he directs, after the example of Hippocrates, to be fastened with a gold thread to those adjoining on each side. Previous to drawing a tooth, he ordered the gum to be cut round its neck; and if the tooth was hollow, it was to be filled with lead before extraction, to prevents its breaking by the forceps. He describes not only the inflammation, but likewise the elongation, of the uvula; he also describes the polypus, and some other diseases affecting the nose. He describes several species of hernia or rupture, and the manual assistance required in those complaints. After the return of the intestines into the abdomen, a firm compress was applied to that part of the groin through which they protruded, and was secured by a bandage round the loins. In some cases, after the return of intestinal ruptures, he diminished the quantity of loose skin, and formed a cicatrix, so as to contract over the part, to render it more rigid and capable of resisting. He describes various diseases of the genital parts, the hydrocele or dropsy of the scrotum, a difficulty of urine, and the manner of drawing off the water by a catheter; the signs of stone in the bladder, and the method of sounding or feeling for that stone. Lithotomy was at that time performed by introducing two fingers into the anus; the stone was then pressed forward to the perinæum, and a cut made into the bladder; and by the finger or by a scoop the slone was extracted. He describes the manner of performing this operation on both the sexes, of treating the patient, and the signs of recovery and of danger. Celsus directed various corrosive applications and injections to fistulas; and, in the last extremity, opened them to the bottom with a knife, ulting upon a grooved instrument or conductor. In old callous ulcers, he made a new wound, by either cutting away the hard edges, or corroding them with verdigris, quicklime, alum, nitre, and with some vegetable escharotics. He mentions the symptoms of caries in the bone; directs the bone to be laid bare, and to be pierced with several holes, or to be burnt or rasped, in order to promote an exfoliation of the corrupted part; afterwards to apply nitre and several other ingredients. One of his applications to a cancer was auripigmentum or arsenic. He directs the manner of tapping the abdomen in ascites, and of drawing blood by the lancet and cuppingglasses. His cupping-glasses seem not to have been so convenient as the modern: they were made either of brass or horn, and were unprovided with a pump. He cured varicose veins by ustion or by incision. He gives directions for extracting the dead foetus from the womb, in whatever position it should present; and, after delivery, to apply to the private parts soft cloths wet in an infusion of vinegar and roses. Celsus's works there is a great redundance and superfluity of plasters, ointments, escharoties, collyriums, of suppurating and discutient cataplasms, and external applications of every kind, both simple and compound: perhaps, amongst the multitude, there are a few useful remedies now laid aside and neglected. In The last writer of consequence who flourished at Rome was Galen, physician to the emperor Marcus Aurelius. His works are for the most part purely inedicinal; although he wrote also on surgery, and made commentaries on the surgery of Hippocrates. He opened the jugular veins, and performed arteriotomy at the temples; directed leeches, scarification, and cuppingglasses, to draw blood. He also described with ae uracy the different species of herniæ or ruptures. In the year 500 flourished Actius, in whose Works we meet with many observations omitted by Celsus and Galen, particularly on the surgical operations, the diseases of women, the causes of difficult labours, and modes of delivery. He also takes notice of the dracunculus, or Guinea worm. Aëtius, however, is greatly excelled by Paulus Egineta, who flourished in 640; whose treatise on surgery is superior to that of all the other ancients. He directs how to extract darts; to perform the operation sometimes required in dangerous cases of rupture or hernia. He treats also of aneurism. Galen, Paulus, and all the ancients, speak only of one species of aneurism, and define it to be "a tumour arising from arterial blood extravasated from a ruptured artery." The aneurism from a dilatation of the artery is a discovery of the moderns. In violent inflammations of the throat, where immediate danger of suffocation was threatened, Paulus performed the operation of bronchotomy. In obstinate defluxions upon the eyes, he opened the jugular veins. He describes the manner of opening the arteries behind the ears in chronic pains of the head. He wrote also upon midwifery. Fabricius ab Aquapendente, a celebrated surgeon of the sixteenth century, has followed Celsus and Paulus as text-books. From the time of Paulus Egineta to the year 900, no writer of any consequence, either on medicine or surgery, appeared. At this time the Arabian physicians, Rhazes and Avicenna, revived in the east the medical art, which, as well as others, was almost entirely extinguished in the west. Avicenna's Canon Medicinæ, or General System of Medicine and Surgery, was for many ages celebrated through all the schools of physic. It was principally compiled from the writings of Galen and Rhazes. The latter had correctly described the spina ventosa, accompanied with an enlargement of the bone, caries, and acute pain. In difficult labours, he recommends the fillet to assist in the extraction of the fœtus; and for the same purpose, Avicenna recommends the forceps. He describes the composition of several cosmetics to polish the skin, and make the hair grow, or fall off. Notwithstanding this, however, it was not till the time of Albucasis that surgery came into repute among the Arabians. Rhazes complains of their gross ignorance, and that the manual operations were performed by the physicians' servants. Albucasis enumerates a tremendous list of operations, sufficient to fill us with horror. The hot iron and cauteries were favourite remedies of the Arabians; and, in inveterate pains, they reposed, like the Egyptians and eastern Asiatics, great confidence in burning the part. He describes accurately the manner of tapping in ascites; mentions several kinds of instruments for drawing blood; and has left a more ample and correct delineation of surgical instruments than any of the ancients. He gives various obstetrical directions for extracting the foetus in cases of difficult labour. He mentions the bronchocele, or prominent tumor on the neck, which, he tells us, was most frequent among the female sex. We are also informed by this writer, that the delicacy of the Arabian women did not permit male surgeons to perform lithotomy on females; but when necessary, it was executed by one of their own sex, From the eleventh century to the middle of the fourteenth, the history of surgery affords nothing remarkable except the importation of that nauseous disease the leprosy into Europe. Towards the end of the fifteenth century the venereal disease is said, though apparently without foundation, to have been imported from America by the first discoverers of that continent. At the beginning of the sixteenth century, surgery was held in contempt in this island, and was practised indiscriminately by barbers, farriers, and sow-gelders. Barbers and surgeons Continued, for 200 years after, to be incorporated in one company both in London and Paris. In Holland and some parts of Germany, even at this day, barbers exercise the razor and lancet alternately. It is only within the last three centuries that we have made any considerable improvement in surgery; nor do we know of any eminent British surgical writers until within the last 130 years. "In Germany (says Heister) all the different surgical operations, at the beginning even of the eighteenth century, were left to empirics; while regular practitioners were contented to cure a wound, open a vein or an abscess, return a fractured or luxated bone; but they seldom or never ventured to perform any of the difficult operations." He also speaks of their gross ignorance of the Latin language. The first surgical work of the sixteenth century worthy of notice is that of J. Carpus. F. ab Aquapendente, an Italian, published about the same period a System of Surgery; containing a description of the various diseases, accidents, and operations. Boerhaave pays this author the following compliment: Ille superavit omnes, et nemo illi hanc disputat gloriam; omnibus potius quam hocce carere possumus. Not long afterwards, A. Parey, a Frenchman, made several important additions to surgery, particularly in his collection of cases of wounds, fractures, and other accidents which occur during war. The ancients, who were ignorant of powder and fire-arms, are defective in this part of military surgery. Parey pretends to have first invented the method of tying, with a needle and strong silk-thread waxed, the extremities of large arteries, after the amputation of a member. The ligature of the blood vessels is, however, merely a revival of the ancient practice, which had fallen into disuse: throughout the dark ages, the hot iron, cauteries, and strong astringents, were substituted in its place. B. Maggius and L. Botallus wrote on the cure of gun-shot wounds. J. A. Cruce wrote a system of surgery. In the seventeenth century, surgery was enriched with several systems, and with a greater variety of detached or miscellaneous observations. The principal authors are, M. A. Severinus, V. Vidius, R. Wiseman, Le Clerc, J. Scultetus, J. Mangetus, C. Magatus, Spigellius, F. Hildanus, T. Bartholin, P. de Marchett. It is chiefly, however, since the commencement of the last century that this art has flourished in any very considerable degree; and so numerous are the excellent writers upon it, that we have not space to transcribe even a list of their names. Yet we ought not to close this part without strongly recommending to the young student to peruse, as systematic works, those of Latta, Richter, and Callisen; and as highly valuable works upon detached or miscellaneous subjects, the publications of Le Dran, Sabatier, Desault, Bertrandi, Scarpa, John Hunter, Sharp, Home, Abernethy, Hey, and Astley Cooper. We now enter upon the practical branch of the present article, which we shall endeavour to arrange in as systematic a method as it will perhaps bear, and shall for this purpose deviate from the looser manner in which it has hitherto been generally treated of. We shall not venture, however, upon the common terms employed in a classific arrangement, but shall modestly content ourselves with those of part, division, chapter, and section, instead of class, order, genus, and species. The different subjects that comprise the art of surgery may, as it appears to us, be conveniently distributed, in the first place, into two parts, lesions, or accidental affections, and diseases, or constitutional affections. Our secondary partitions, which we shall call divisions, may be taken for both the preceding parts, from the nature of the organs affected, as soft or hard. Our third set of partitions will be characterised by the nature of the complaint, or of the necessary mode of attending to it, which we shall denominate chapters; and our fourth, or subordinate set of partitions, sections. CHAPTER I. Wounds. SECTION I. Simple Wounds. The first thing to be considered in the inspection of a wound is, whether it be likely to prove mortal or not. This knowledge can only be had from anatomy, by which the surgeon will be able to determine what parts are injured; and, from the offices which these parts are calculated to perform, whether the human frame can subsist under such injuries. It is not, however, easy for the most expert anatomist always to prognosticate the event with certainty; but this rule he ought always to lay down to himself, to draw the most favourable prognosis the case will bear, or even more than the rules of his art will allow. This is particularly incumbent on him in sea engagements, where the sentence of death is often executed as soon as pronounced, and the miserable patient is thrown alive into the sea, upon the surgeon's declaring his wound to be mortal. There are, besides, many instances on record, where wounds have healed, which the most skilful surgeons have deemed mortal. The following wounds may be reckoned mortal. 1. Those which penetrate the cavities of the heart, and all those wounds of the viscera where the large blood-vessels are opened; because their situation will not admit of proper applications to restrain the flux of blood. 2. Those which obstruct or entirely cut off the passage of the nervous influence through the body. Such are wounds of the brain, cerebellumi, medulla oblongata, and spinal marrow; though the brain is sometimes injured, and yet the patient recovers. Wounds likewise of the small blood-vessels within the brain are attended with great danger, from the effused fluids pressing upon the brain. Nor is there less danger where the nerves which tend to the heart are wounded, or entirely divided; for, after this, it is impossible for the heart to continue its motion. 3. All wounds which entirely deprive the animal of the faculty of breathing. 4. Those wounds which interrupt the course of the chyle to the heart; such are wounds of the <. f the chyle, thoracic duct, and larger are other wounds which prove fatal 4 and left to nature: such are wounds r external blood-vessels, which might by ligature. ining wounds, the next consideration the parts injured are such as may be to induce dangerous symptoms, either ely or in some time during the course In order to proceed with any degree ty, it is necessary to be well acquainted e symptoms which attend injuries of nt parts of the body. If the skin only of the cellular substance is divided, the sequence is an effusion of blood; the ⚫ wound retract, become tumefied, red med, leaving a gap of considerable according to the length and deepness ound. Besides, if a very considerable skin and cellular substance is divided, fever scizes the patient; the effusion of the mean time stops, and the wound is led up with a cake of coagulated blood. This cake, the small vessels pour forth a mor, which in a short time is converted Below this pus granulations of new se, the cake of coagulated blood looseas, skin covers the place where the wound d the whole is healed up; only there sa mark, called a cicatrix or scar, showere the injury had been received. wounds are accompanied with a considergree of pain, especially when the inflamcomes on, though the division reaches no than the skin and cellular substance. muscular fibres are divided, the pain is greater, because the sound part of the e is stretched by the contraction of the dipart and the action of the antagonist muswhich it is now less fitted to bear. The d also gaps much more than where the celsubstance only is divided, insomuch that, it to itself, the skin will cover the muscular s, without any intervention of cellular sube; and not only a very unsightly cicatrix ains, but the use of the muscle is in some sure lost. If the muscle happens to be ly divided, its parts retract to a very consiable distance; and unless proper methods be en, the use of it is certainly lost ever afterrds. In the cure of wounds the ancients imagined Isams, the juice of herbs, &c. to be a kind of ifies. In after-ages, and in countries where sams are not easily to be procured, salves ve been substituted in their place; and even this day there are many who reckon a salve or ntment essentially necessary for healing the ightest cut. It is certain, however, that the re of wounds cannot be effected, nay, not even rwarded in the least, by ointments, unless in particular cases or by accident. That power hich the human frame has of repairing the juries done to itself, which by physicians is called vis medicatrix naturæ, is the sole agent in Curing external injuries; and without this the most celebrated balsams would prove ineffectual. When a wound has been made with a sharp instrament, and is not extensive, if it be immediately cleaned, and all the extravasated blood fucked out, it will almost always heal by the first intention in a very short time. Indeed the cures performed by this simple process are so surVOL. XI. prising, that they would be incredible were wa not assured of their reality by eye-witnesses. When this process is either neglected or proves unsuccessful, there are three stages to be observed in the cure of a wound: the first, called digestion, takes place when the ends of the wounded vessels contract themselves, and pour out the liquor which is converted into pus. As soon as this appears, the second stage, in which the flesh begins to grow up, takes place; and as this proceeds, the edges of the wound acquire a fine bluish or pearl colour, which is that of the new skin beginning to cover the wound as far as the flesh has filled it up. This process continues, and the skin advances from all sides towards the centre, which is called the cicatrizing of the wound. For the promoting of each of these processes, several ointments were formerly much in vogue. But it is now found, that no ointment whatever is capable of promoting them; and that it is only necessary to keep the wound clean, and to prevent the air from having access to it. This, indeed, nature takes care to do, by covering the wound with a cake of coagulated blood; but if a wound of any considerable magnitude should be left entirely to nature, the pus would form below the crust of coagulated blood in such quantity, that it would most probably corrupt, and the wound degenerate into a corroding ulIt is necessary, therefore, to cleanse the wound frequently; and for this purpose it will be proper to apply a little ointinent spread on soft scraped lint. For the first dressing, dry liat is usually applied, and ought to be allowed to remain for two or three days, till the pus is perfectly formed; after which the ointment may be applied as just now directed; and, in a healthy body, the wound will heal without further trouble. As to the ointment employed, it is almost indifferent what it be, provided it has no acrid or stimulating ingredient in its composition. cer. But though, in general, wounds thus easily admit of a cure, there are several circumstances which require a different treatment, even in simple divisions of the fleshy parts, when neither the membranous nor tendinous parts are injured. These are, 1. Where the wound is large, and gapes very much, so that, if allowed to heal in the natural way, the patient might be greatly disfigured by the scar. It is proper to bring the lips of the wound near to each other, and to join them either by adhesive listeror by suture, as the wound is more superficial, or lies deeper. 2. When foreign bodies are lodged in the wound, as when a cut is given by glass, &c. it is necessary by all means to extract them, before the wound is dressed; for it will never heal until they are discharged. When these bodies are situated in such a manner as not to be capable of being extracted without lacerating the adjacent parts, which would occasion violent pain and other bad symptoms, it is necessary to enlarge the wound, so that these offending bodies may be easily removed. This treatment, however, is chiefly necessary in gunshot wounds, of which we shall treat in the next section. 3. When the wound is made in such a manner that it runs for some length below the skin, and the bottom is much lower than the orifice, the matter collected from all parts of the wound will be lodged in the bottom of it, where, corrupting by the heat, it will degenerate into a fistulous ulcer. To prevent this, we must use compresses, applied so that the bottom of the wound may suiter ☛ more considerable pressure than the upper part of it. Thus the matter formed at the bottom will be gradually forced upwards, and that formed at the upper part will be incapable of descending by its weight; the divided parts, in the mean time, easily uniting when brought close together. Indeed, the power which nature has of uniting different parts of the human body is very surprising; for, according to authors of credit, even if a piece of flesh be totally cut out, and applied in a short time afterwards to the place from whence it was cut, the two will unite. That a part cut out of a living body does not entirely lose its vital power for some time, is evident from the modern practice of transplanting teeth; and from an experiment of Mr. Hunter's at London, he put the testicle of a cock into the belly of a living hen, which adhered to the liver, and became connected to it by means of bloodvessels. We have therefore the greatest reason to hope, that the divided parts of the human body, when closely applied to each other, will cohere without leaving any sinus or cavity between them. However, if this method should fail, and matter still be collected in the depending part of the wound, it will be necessary to make an opening in that part in order to let it out; after which the wound may be cured in the common way. 4. During the course of the cure, it sometimes happens that the wound, instead of filling up with fleshy granulations of a florid colour, shoots up into a glassy like substance which rises above the level of the surrounding skin, while, at the same time, instead of laudable pus, a thin ill-coloured and fetid ichor is discharged. In this case the lips of the wound lose their beautiful pearl colour, and become callous and white, nor does the cicatrizing of the wound at all advance. When this happens in a healthy patient, it generally proceeds from some improper management, especially the making use of too many emollient and relaxing medicines, an immoderate use of balsams and ointments. Frequently nothing more is requisite for taking down this fungus than dressing with dry lint; at other times desiccative powders, such as calamine, tutty, calcined alum, &c. will be necessary; and sometimes red precipitate mercury must be used. This last, however, is apt to give great pain, if sprinkled in its dry state upon the wound; it is therefore most proper to grind it with some yellow basilicon ointment, which makes a much more gentle, though at the same time an efficacious escharotic. Touching the overgrown parts with blue vitriol is also found very effectual. Diet and Regimen. Hitherto we have considered the wounded patient as otherwise in a state of perfect health; but it must be observed, that a large wound is capable of disordering the system to a great degree, and inducing dangerous diseases which did not before exist. If the patient be strong and vigorous, and the pain and inflammation of the wound great, a considerable degree of fever may arise, which it will be necessary to check by bleeding, low diet, and other parts of the antiphlogistic regimen, at the same time that the inflamed lips of the wound and parts adjacent are to be treated with emollient fomentations or cataplasms till the pain and swelling abate. On the other hand, it may happen, when the patient is of a weak and lax habit, that the vis vitæ may not be sufficient to excite such an inflammation in the wound as is absolutely necessary for its cure. In this case, the edges of the wound look pale and soft; the wound itself ichorous and bloody, without any signs of fleshy granulations; or if any new flesh shoots up, it is of the fungous glassy kind above mentioned. To such wounds all external applications are vain; it is necessary to strengthen the patient by proper internal remedies, among which the bark has a principal place, until the wound begins to alter its appearance. In such persons, too, there is some danger of a hectic fever by the absorption of matter into the body when the wound is large; and this will take place during the course of the cure, even when the appearances have been at first as favourable as could be wished. This happens generally when the wound is large, and a great quantity of matter formed: for by this discharge the patient is weakened; so that the pus is no sooner formed, than it is by the absorbent vessels re-conveyed into the body, and feverish heats immediately affect the patient. For this the best remedy is to exhibit the bark copiously, at the same time supporting the patient by proper cordials and nourishing diet. Indeed, in general, it will be found, that, in the case of wounds of any considerable mag. nitude, a more full and nourishing regimen is required than the patient, even in health, has been accustomed to; for the discharge of pus alone, where the quantity is considerable, proves very debilitating, if the patient is not strengthened by proper diet. And it is constantly found, that the cure of such sores goes on much more easily when the patient is kept in his usual habit of body, than when his system is much emaciated by a very low allowance; and, for the same reason, pargatives, and whatever else tends to weaken the constitution, are improper in the cure of wounds. Wounds of the Nerves, Tendons, or Ligaments. These are attended with much more violent symptoms than those where even considerable arteries are divided, and frequently resist every method of cure proposed by the most skilful practitioners. In the simple process of bloodletting, it frequently happens that the tendinous expansion called the aponeurosis of the biceps muscle is wounded, or even the tendon of that muscle itself is punctured, by the point of the lancet; or sometimes a nerve which happens to lie in the neighbourhood is partially divided. Any one of these wounds, though they are the smallest we can well suppose to be given, are frequently very dangerous and difficult of cure. It sometimes immediately happens on the introduction of the lancet, that the patient complains of a most exquisite degree of pain; and when this occurs, we may rest assured that either a nerve or tendon has been wounded. On some occasions, by proper management, such as evucuating a considerable quantity of blood at the orifice newly made, by keeping the part at perfect rest, and preserving the patient in as cool a state as possible, the pain at first complained of will gradually abate, and at last go off entirely without any bad consequence whatever. At other times, however, this pain which occurs instantaneously on the introduction of the lancet, instead of abating, begins soon to increase; a fullness, or small degree of swelling, takes place in the parts contiguous to the wound; the lips of the sore become somewhat hard and inflamed; and in the course of twenty-four hours or so |