If the object which produced the puncture is still lodged in the tissues, it must, as a matter of course, be withdrawn. After which, the further measures to be adopted may be enumerated under the following heads: careful regulation of the manner of living; removal from the system of all material which—attracted to the wounded part by the pain—might there cause irritation or inflammation; and protection of the body against any harm that might come to it through the occurrence of convulsions. These three measures are indicated for all wounds of nerves. But, in the case of a punctured wound, still other procedures should be employed, as will be discussed under a fourth head.
The four heads mentioned by Guy may be briefly stated
in the following terms: I. The patient should be put upon
a light and very simple diet; and, in addition, he should be
given a bed that is soft and humid ("humidus et mollis").
His surroundings should be kept quiet, and nothing should
be permitted to disturb his peace of mind. II. To protect
his tissues from the injurious influence of any superfluous
matters of an irritating nature that may be circulating in
the blood (i.e., cacochyme), a vein on the opposite side of
the body should be opened and a certain amount of this
fluid withdrawn. In certain cases, furthermore, it may be
well, in addition, to administer an aperient remedy. III. If
convulsions develop, the head, neck and the entire back
should be anointed with well-warmed linseed oil or common
(? olive) oil, as recommended by Galen. IV. Special
measures should be adopted for providing a free outlet for
any pus that may form in the deeper parts of the wound;
and here again Galen recommends for this purpose the
employment of one of several medicinal preparations which
he enumerates. "But the more certain course," Guy adds,
"is to make an opening in the skin either with the razor or
with the actual cautery (which latter, according to Henri
de Mondeville, is the better plan of the two), and then to
apply some subtle drying remedy which possesses the power
to penetrate into the deepest recesses of the injured
nerve—for example, savin oil." (Guy has a good deal
more to say on the subject of wounds of nerves, but the
few extracts given above should suffice.)
