WOUNDS. 249 



Immediate (Jmon. — This can only be effected in incised 

 wounds where the tissues are evenly divided. The lips of the 

 wound should be immediately brought together; the blood, if 

 any be shed, is thus pressed out, and the divided blood vessels 

 and nerves are brought into perfect coH^act and union readily 

 takes place. It is necessary that the parts be in perfect contact 

 and in complete repose, and that means be taken to prevent the 

 occurrence of inflammation. 



Primary Adhesion. — When the mouths of the divided ves- 

 sels are entirely closed, an inflammation of the parts invariably 

 follows, and furnishes the material for union by throwing out 

 coagulable lymph. The lymph connects the two cut edges, and 

 finally forms between them a thin layer of connective tissue, on 

 the surface of which a layer of cuticle is developed. UnioH by 

 primary adhesion may be accomplished in a very short time, 

 usually in two or three days. 



Healing by Granulation. — It is by this method that the 

 majority of wounds heal. At first a considerable extravasation 

 of blood takes place. Soon the blood gradually ceases to flow 

 from the surface of the wound; it becomes paler, and ultimately 

 collects, like a whitish film glazing on the surface, containing an 

 abundance of corpuscles, which become converted into pus cor- 

 puscles. The next process is the production of the material to 

 be organized into granulations. It is seen to fill up the wound, 

 being a substance of a velvety character. These are the granu- 

 lations. If examined microscopically, there will be seen nu- 

 merous cells heaped together, irregularly arranged and con- 

 nected by intermediate substance, termed protoplasm. They 

 are of varying sizes and shapes. The development of tlu> cells 

 gradually assumes the character of connective tissue, and the 

 wound gradually fills up, healing from the bottom. Granula- 

 tions are sometimes arrested in their development; from some 

 unknown causes, as in indolent wounds and ulcers, the cells will 

 not develop for weeks. Sometimes there is excessive granula- 



