METHODS OF »IEALIMG. A75- 



"By what is terra ed immediate union is meant tliatproces* 

 wherebj' tlie divided parts are rejoined without the production 

 or the interposition of any new matenaL Air. Hunter main- 

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

 the fibrine of the blood extravasated between the surfaces of 

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

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

 • of union between thein. but it is now admitted that he was 

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

 of the paiis ; the apposition of their surfaces restoring the 

 vitality and circulation. 



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

 ence on their repair, and there are eWdences 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 ftbrons cords [as L have seen in farcy], or clots 

 organizing into tumours in the heart and arteries, and the 

 clota 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, "t 

 becomes a question — "When blood is effused and coagulated 

 between wounded surfaces, how are the clots disponed of ? 

 For often, though not generaUy. sQch clots are foaud -n wounds, 

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

 when an artery t)Y -ts side is cut ; and in most operaiioa- 

 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 effiLsed in large quantity, so as to form a large clot, and 

 especially if so effused in a wound which is not perfect I v 

 excluded from the air. or if effused even m 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, m moro 

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

 happen when it has formed separate clots, or more readily- 



