METHODS OF HEALING. 475 



" By what is termed immediate union is meant that process 

 whereby the divided parts are rejoined without the production 

 or the interposition of any new material. Mr. Hunter main- 

 tained that union by the first intention is effected by means of 

 the fibrine of the blood extravasated between the surfaces of 

 the injured part, which fibrine, there coagulating, adheres to 

 both the surfaces, becomes organized, and forms a vascular bond 

 of union between them. But it is now admitted that he was 

 in error, and that this form of repair is simply the restoration 

 of the parts ; the apposition of their surfaces restoring the 

 vitality and circulation. 



" But blood extravasated in wounds is not without its influ- 

 ence on their repair, and there are evidences to prove that 

 masses of effused, or stagnant, or coagulated blood may be 

 organized. These evidences include cases of blood effused in 

 serous sacs, especially in the arachnoid, or clots in veins 

 organizing into fibrous cords [as I have seen in farcy], or clots 

 organizing into tumours in the heart and arteries, and the 

 clots so organized above ligatures on arteries as to form part of 

 the fibrous cord by which the obliterated artery is replaced. 

 But there is also evidence quite sufficient to show that extra- 

 vasated blood is not at all necessary for union by the first in- 

 tention, or for any other mode of repair ; and the fact is that 

 the repair is best, and the material for it most ample, where no 

 blood is extravasated. But though this be the usual case, it 

 becomes a question — When blood is effused and coagulated 

 between wounded surfaces, how are the clots disposed of ? 

 For often, though not generally, such clots are found in wounds, 

 or between the ends of a broken bone, or a divided tendon, 

 when an artery by its side is cut ; and in most operation- 

 wounds one sees blood left on them, or flowing on their surface, 

 when they are done up. How, then, is this blood disposed of ? 

 If effused in large quantity, so as to form a large clot, and 

 especially if so effused in a wound which is not perfectly 

 excluded from the air, or if effused even in a subcutaneous 

 injury, this blood is most likely to excite inflammation ; and 

 the swelling of the wounded parts, or their commencing 

 suppuration, will push it out of the wounds ; or, in more 

 favourable cases, the blood may be absorbed, and this may 

 happen when it has formed separate clots, or more readily 



