WOUNDS. 229 



puration can be induced, the life of the patient may be 

 saved ; but in a majority of cases it runs on, terminating 

 in gangrene and death. Phlegmonous erysipelas occasionally 

 follows the use of setons, and is a very undesirable occur- 

 rence, as the operator may be blamed, though unjustly, for 

 the result. 



Modes of Healing. — AYounds heal in various ways, and 

 the mode of healing depends upon certain conditions, as 

 the character of the wound, the way in which it is treated, 

 the state of the patient's health, etc. 



Direct, or Immediate Union. — This is the most desirable 

 way, and can take place only in an incised wound, where 

 the tissues are smoothly and evenly divided, without any 

 tearing or lacerating of the parts. The haemorrhage being 

 arrested, the lips of the wound are brought together, and it 

 is left to heal. There is no great amount of inflammatory 

 action, though possibly there may be some, and it heals 

 in from twenty-four to forty-eight hours. This mode of 

 healing usuall}^ occurs after the operation of phlebotomy ; 

 but is seen oftener in man than in our patients. 



Adhesion, or Healing by the First Intention. — In this 

 there is a certain amount of inflammation set up, not, 

 however, of a severe character. Leucocytes are thrown 

 out, and soon become converted into fibre cells. Healing 

 by the first intention cannot take place if the inflammatory 

 action be excessive. 



Granulation, or Healing by the Second Intention. — It is 

 by this method that most of the wounds in our patients 

 heal. The parts as a general thing are brought together in 

 some manner or other, after which a considerable extrava- 

 sation of blood and serum takes place. This escapes in the 

 course of twenty-four hours or so. There is a great influx 

 of leucocytes, which become converted into pus corpuscles, 

 and the cavity of the wound begins to fill up with a sub- 



