REUNION. 143 



Mm only to the extent of preventing accidents and maintaining 

 natui'al conditions. The processes, the order, and the rapidity of 

 the formation of cicatrization are not the same with different tis- 

 sues, and certain distinctive terms have therefore been adopted 

 by which to denote the modified ways by which the pur^DOse of 

 natui'e is effected. Thus we have immediate reunion or adhesive 

 hiflammatlon or union by the first intention, by which separated 

 parts sohdify upon simple contact, as varying from union by the 

 second intention, or by granulation and suppm-ation ; followed by 

 union by the third intent io?i, when, together with the processes of 

 the second intention, there is added one of mortification and the 

 elimination of dead structure. This subdivision accords strictly 

 with the order of nature, as it may be constantly observed, the 

 phenomena of separation involving a regular gradation of de- 

 tail in the active forces employed in the recuj)erative effort, from 

 the simplest and most efficient in the uniofi by first intention to 

 that which is, in fact, a struggle between the elements of growth 

 and preservation and the tendency to dissolution and death, as ex- 

 hibited in the third degree. 



Before j^roceeding to the direct discussion of the means used 

 to assist the vis conservatrix in the reunion of divided parts, there 

 are some general considerations of which the surgeon must never 

 lose sight. They are not of the less importance because they are 

 matters of an obvious and secondary character, and refer mainly to 

 what may be termed matters of minor detail. Where immediate 

 reunion is looked for, the wound must be fresh and clean, and 

 entirely free from clots of blood or foreign substances. The edges 

 must be smooth and even, and if there are any ragged portions 

 they must be carefully excised. In addition to this, where there 

 is a granulating surface the granulations must be carefully inspect- 

 ed and their healthiness assured, and the surgeon must search care- 

 fully to ascertain that there are no fistulous tracts present. In any 

 case the hair must be cHpped short around the edges, the skin thor- 

 oughly washed, and, what is a point of primary importance, the 

 exact coaptation of the opposite edges carefully ascertained and 

 secured. 



The means employed to maintain the contact of the edges of a 

 wound, and assist in its closure are, according to Gourdon, of 

 four kinds — -position, uniting bandages, adhesive plasters and 

 sutures. 



