476 WOUNDS. 



when it is infiltrated into the tissues. The absorption of 

 blood is a very slow process, and takes as much time as the 

 healing of a fracture ; it is therefore the best plan, always in 

 cases of punctures with small openings to enlarge the orifices 

 and remove the clot, if not very deep seated. The best time 

 for doing this is about the third day after the infliction of the 

 injury, as by that time there is not much danger of secondary 

 haemorrhage, the mouths of the wounded vessels being sealed 

 by exudation. But if the blood is left in a wound, its absorp- 

 tion seems to be thus — that it is enclosed within the repara- 

 tive material, and absorbed by the vessels of that material as its 

 organization proceeds. In conclusion, extravasated blood is — 

 1st. Neither necessary nor advantageous to any mode of healing; 

 2d. A large clot at all exposed to the air irritates and is ejected ; 

 Sd. In more favourable conditions the effused blood becomes 

 enclosed in the accumulated reparative material, and while this 

 is organizing, the blood is absorbed ; and lastly, it is probable 

 that the blood may be organized and form part of the repara- 

 tive material ; but even in this case it probably retards the healing 

 of the injury." — (Paget's Surgical Pathology.) 



IMMEDIATE UNION. 



The observations of Paget and other modern surgical investi- 

 gators being conclusive that the fibrine of extravasated blood 

 plays no essential part in the process of healing, it will now be 

 necessary to follow the same observers into the various modes 

 by which repair is effected. 



1st. Immediate union is effected in some cases of incised 

 wounds that admit of being with safety and propriety closely 

 and immediately bound together ; the blood, if any be shed, is 

 thus pressed out, and the divided blood-vessels and nerves are 

 brought into perfect contact, and union may take place in a few 

 hours ; and as no intermediate substance exists in a wound so 

 healed, no mark or cicatrix is left behind.— (Macartney's 

 Treatise on Inflammation.) 



In order that this process may be fulfilled, it is necessary 

 that the parts be in perfect contact, and in complete repose, 

 and that means be taken to prevent the occurrence of inflam- 

 mation. 



