a small roll of rubber, form a satisfactory
substitute. Except when infection occurs, the drain is removed in from
one to four days and the opening closed with a Michel's clip or a
suture.

#Punctured Wounds.#--Punctured wounds are produced by narrow, pointed
instruments, and the sharper and smoother the instrument the more does
the resulting injury resemble an incised wound; while from more rounded
and rougher instruments the edges of the wound are more or less contused
or lacerated. The depth of punctured wounds greatly exceeds their width,
and the damage to subcutaneous parts is usually greater than that to the
skin. When the instrument transfixes a part, the edges of the wound of
entrance may be inverted, and those of the exit wound everted. If the
instrument is a rough one, these conditions may be reversed by its
sudden withdrawal.

Punctured wounds neither gape nor bleed much. Even when a large vessel
is implicated, the bleeding usually takes place into the tissues rather
than externally.

The _risks_ incident to this class of wounds are: (1) the extreme
difficulty, especially when a dense fascia has been perforated, of
rendering them aseptic, on account of the uncertainty as to their depth,
and of the way in which the surface wound closes on the withdrawal of
the instrument; (2) different forms of aneurysm may result from the
puncture of a large vessel; (3) perforation of a joint, or of a serous
cavity, such as the abdomen, thorax, or skull, materially adds to the
danger.

_Treatment._--The first indication is to purify the whole extent of the
wound, and to remove any foreign body or blood-clot that may be in it.
It is usually necessary to enlarge the wound, freely dividing injured
fasciae, paring away bruised tissues, and purifying the whole
wound-surface. Any blood vessel that is punctured should be cut across
and tied; and divided muscles, tendons, or nerves must be sutured. After
haemorrhage has been arrested, iodoform and bismuth paste is rubbed into
the raw surface, and the wound closed. If there is any reason to doubt
the asepticity of the wound, it is better treated by the open method,
and a Bier's bandage should be applied.

#Contused and Lacerated Wounds.#--These may be considered together, as
they so occur in practice. They are produced by crushing, biting, or
tearing forms of violence--such as result from machinery accidents,
firearms, or the bites of animals. In addition to the irregular wound