with regard to his qualifications as a surgeon. But all of these descriptions, when rendered in their entirety into English, occupy much space, and for this reason I shall be obliged to furnish here merely a few extracts from some of the more interesting portions of the text.
In the chapter which Guy devotes to wounds of nerves, cords and ligaments—all of which structures were classed by him, as well as by Galen, as belonging to the category of nerves—this author divides them into punctured and incised wounds, bruises and concussions. As to the first variety he says that they may be divided into closed punctured and open punctured wounds.
In the incised wounds two kinds may be distinguished: those in
which the nerve is incised in the direction of its length and those
in which the cut is made across the fibres. A further subdivision
is practicable, viz., into wounds accompanied by more or less
destruction of the substance of the nerve or its envelopes, and those
in which such loss has not occurred. Among other differences
worthy of mention are these: pain, spasmodic phenomena, and
abscess formation are present in certain cases and absent in others.
From all of which symptoms useful indications as to the treatment
needed may be deduced.
In the section relating to the treatment of such traumatic
affections of nerves, Guy makes the remark that the measures
called for are, for the most part, the same as those
required for wounds involving simply the fleshy parts of
the body.
The element of pain, however, is one of the factors which distinguish
wounds of a nerve from ordinary flesh wounds, and it
may necessitate some slight modification of the treatment. Aside
from this, one of the first things that should be done is to remove
from the wound all foreign substances; after which the edges of
the cavity should be brought together and held firmly in this
position by appropriate means. Last of all, care should be taken
to protect the parts. These are the general principles which are
to guide the surgeon's action. As to the special details, they must
depend upon the different conditions presented by each individual
case. Thus, for example, if we are dealing with a punctured wound
of a nerve, there will be no edges of an excavation to bring together.
