SURGERY.
On the use of Nitrate of Silver in Lacerated Wounds. By John
Higginbottom, Esq., F. R. C. S., Nottingham.
Lacerated Wounds of the Face.—Case 1,—Miss R-----, aged twenty.
On a very windy day, a piece of slate was blown from the roof of a
house, which fell upon her forehead, and inflicted a wound of five inches
in length, commencing on the forehead, above the right eye, passing
obliquely across the nose, and terminating on the left cheek, leaving a
large open wound, quite disfiguring the face. The wounded parts, after
being well cleansed from extraneous matter, were neatly closed by the
interrupted suture ; the nitrate of silver was then applied along the edges
of the wound, on the line of the wound, and also on the surrounding
skin. Afterwards, strips of adhesive plaster were applied, without any
other covering.
The wound healed by the first intention, and required no further
application. It is now several years since the accident. A common
observer standing at a short distance, cannot see the mark of the union,
for no disagreeable mark or cicatrix remains.
Great advantages are derived from healing lacerated wounds on the
face by the aid of the nitrate of silver.
1.	It prevents irritation arising from the irregular edges of a lacerated
wound, and it induces adhesive inflammation as readily as in an incised
wound.
2.	The inflammation, swelling, and irritative fever, consequent on
lacerated wounds, are in a great measure prevented, and there being no
ulcerative process, there is no loss of substance, so that unsightly scars
and raised cicatrices are obviated.
Case 2. A boy was standing on a wall, supporting himself against
some iron palisades fixed in the wall. Not having a firm footing, his
feet slipped, and he threw his head forward, and his cheek came in
contact with a sharp iron spike at the top of one of the palisades : it
pierced through the lower part of the cheek, fractured the malar bone,
and perforated the upper part of the cheek, so as to cause two lacerated
wounds, two inches in length, one above the fractured bone, and the
other below.
After the parts had been washed, the wound was closed by two in-
terrupted sutures; the nitrate of silver was applied to the edges of the
wound, to destroy their irritability, and an inch upon the surrounding
skin ; also over the surface of the small line of wound that was left ex-
posed ; but not within the wound. Adhesive strips were applied to
support the part; no bandage was put over it.
In four days the wounds had healed by the first intention, except a
small opening in the lower wound. The ligatures were removed on the
third day, and the slight orifices made by the removal of the ligatures
were touched with the nitrate of silver, to prevent inflammation or
ulceration.
It was observed that a clear fluid flowed from the small opening that
remained in the lower wound, which was found to arise from a wound
of the salivary duct.
After three applications of the nitrate of silver, to form an adherent
eschar, this small opening was closed ; and in three weeks there was no
further discharge of saliva, the wound being healed,
The use of the nitrate of silver, in parotid fistula, I had previously
practised, in a case of seventeen years’ duration, published in the Lon-
don and Physical Journal for January, 1830. In this case there were
two orifices—one was healed by the nitrate of silver ; the other, with
the concentrated sulphuric acid.
Lacerated Perinceum.—Mrs. H--------, on her first labour, drew herself
suddenly away from any assistance at the moment of the birth of the
head of the child; and in consequence the perinseum was lacerated just
above the right side of the median line, entirely through the sphincter
ani.
The parts were directly united by the interrupted suture in two
places, and the nitrate of silver applied along the skin on each side,
close to the line of the wound, and on the line of the wound, and leit
without any other dressing.
No swelling or inflammation followed to require any other treatment.
On the expiraiion of the second day, a dose of castor oil was given,
which had the desired effect of opening the bowels without disturbing
the parts.
On the third day, the sutures were removed, and the ligature marks
touched with nitrate of silver to prevent ulceration. The wound united
by the first intention ; there was no swelling ; and it is worthy of obser-
vation, that the eschar surrounding the laceration made by the nitrate
of silver had the power of fixing the parts as if adhesive plaster had been
applied.
No further treatment was required, and the patient experienced no
future inconvenience. It is now thirteen years since this case occurred,
and the patient has borne nine children, but there has been no other
laceration.
On examining the part lately, the mark of the wound is scarcely
perceptible, except that one point is a little raised at the anterior edge
of the perinaeum.
If another case should occur, I should use the catheter to draw off the
urine for the first three or four days, although in this case no injury was
sustained by its neglect.—London Lancet.