WOUNDS. 



tain whether there are extraneous fubftiiices in the flefti or 

 not ; but in open incifed wounds no fucli diJSculty and ob- 

 fcurity prevail, and the praftitioner who clofes them, with- 

 out having affured himfelf that they are perfeftly free from 

 all extraneous matter, betrays either the moft fupine negli- 

 gence, or an utter ignorance of his profeffional duty. It is 

 true an incifed wound made with a clean, fharp inftrument, 

 which has not broken, can obvioufly have no foreign bodies 

 in it. But very confiderable and dangerous cuts are often 

 produced by glafs, china, Sec. v/hich are apt to break at 

 the moment, and leave fome of their fragments in the 

 part. Sometimes alfo the weapon with which the wound 

 is made is unclean, and occafionally dirt, gravel, &c. get 

 into the wound, in confequence of the patient falling upon 

 the ground at the time when he receives the injury. We 

 (hall merely repeat, that as extraneous bodies operate as an 

 irritation to all kinds of wounds, the furgeon ought to take 

 cai-e to remove them immediately the bleeding veffels have 

 been fecured. 



Mr. John Hunter believed, that blood retaining the living 

 principle was rather an ufeful fubftance in the union of 

 wounds than otherwife ; and he only confidered blood, which 

 had been deprived of this principle by long expofure, the 

 effeft of ftyptics, &c. as hurtful, when left on the furface 

 of the wound. Yet this is a doftrine which is by no means 

 fandtioned by the approbation of the beft modern prafti- 

 tioners, all of whom are decidedly of opinion, that leaving 

 any blood upon the furface of a recent wound, when the 

 oppolite furfaces of fuch wound are to be brought into con- 

 taft, is difadvantageous, retarding the cure, and rendering 

 union by the firft intention lefs certain. The prefence of 

 blood in the cavity of the wound, indeed, muft have the 

 effeft of producing a greater or lefTer feparation of thofe 

 f irfaces, which ought ftriftly to touch each other ; and we 

 decidedly believe, that the praftice of freeing wounds as much 

 as poffible from clots of blood may be fuccefsfuUy defended 

 both upon theoretical and praftical principles. 



3. Union of the Wound, DreJJtngs, Isfc. — We have faid, that 

 when the furgeon has ftopped the bleeding, removed extra- 

 neous fubftances, and properly cleaned the wound, the next 

 indication is to bring the oppofite fides of the injury into con- 

 taft with each other, and keep them quietly and fteadily in 

 this pofition until they have grown together again. Wounds 

 are healed by two procefles ; wz. by one, in which pus is 

 produced, and granulations and new fkin are formed ; and by 

 another, in which, if it perfeftly and univerfally fucceed, no 

 fuppuration whatfoever takes place. The latter, vchen it can 

 be praftifed, is always the moft defirable, becaufe it is not 

 only the quickeft means of cure, but alfo the moll perfeft ; 

 the part being covered by the old original Ikin, which is 

 always ftronger and lefs difpofed to ulceration than what is 

 new formed. Surgeons have termed this way of healing 

 wounds Union by the Firjl Intention, ( fee thefe laft words, ) 

 or Adhefion ; and Mr. Hunter named the procefs by which 

 It, together with many other analogous effefts, was accom- 

 plifhed in the animal body, the Adhefme Inflammation. See 

 Inflammatiok. 



The great recommendations of union by the firft intention 

 are, celerity of cure, the diminution of the pain and inflam- 

 mation arifing from the expofure of raw furfaces, freedom 

 from the inconveniences of fuppuration, the prevention of 

 the deformity, which would otherwife refult from a large 

 cicatrix, and the greater permanency and foundnefs of the 

 cure, for the reafons above ftated. 



The ftrong tendency which divided parts of the animal 

 body have to grow together, when kept a certain time in 

 contaft with each other, is an important faft, of which the 



moderns have taken much more advantage than tlie ancients. 

 There are even cafes and experiments on record in fupport 

 of the opinion, that it is not entirely impoffible for parts 

 entirely detached from the reft of the body to become 

 united again, if quickly replaced. In the article Union' 

 hy the Firjl Intention, we have noticed the interefting experi- 

 ments made by Duhamel and Mr. Hunter. The refearches 

 of the latter celebrated philofopher brought to light feverat 

 very curious and inftruftive facts. He proved that the 

 tefticles of a cock, when removed and introduced into the 

 abdomen of a hen, contraded a vafcular conneftion with the 

 furface of the vifcera, and lived. He afcertained, that a 

 found tooth might be tranfplanted from its focket, and acquire 

 an union to the alveolary procefs of another perfon. He 

 alfo cut off the fpurs of a young cock, and found that they 

 might be made to unite to its comb, or that of another 

 cock, and grow in fuch fituation. The poffibility of this 

 fpecies of union fhews how ftrong the difpofition of the 

 frefh furfaces of an incifed wound muft be to grow together ; 

 particularly when it is confidered, that in the foregoing and 

 in fome of the following inftances, there can be on one fide 

 no affiftance given to the union, as the part entirely feparated 

 from the reft of the body is hardly able to do more than 

 preferve its own living principle, and (as Mr. Hunter ex- 

 prefies himfelf) accept of union. 



The following obfervations on this fubjeft are taken froKi 

 profeffor J. Thomfon's excellent book on inflammation ; 

 " Befides thofe examples that are feen in the tranfplantation 

 of the teeth, it muft be confeffed, that inftances of re-union 

 among parts which had been entirely feparated are very rare 

 in the human body ; fo rare, indeed, that moft praftitioners 

 ftill treat with dift)elief and ridicule the few inftances which, 

 have been put upon record. But the different fafts which 

 have been learned refpefting the tranfplantation of the teeth, 

 together with the experiments of Duhamel and Mr. Hunter, 

 prove indifputably the poflibility of parts being re-united 

 which have been completely feparated from the animal fyf- 

 tem to which they belonged, and in which the circulation 

 of the blood muft neceffarily have ceafed for a time. There 

 is nothing therefore in the nature of the faft recorded, that 

 can juftify us, I conceive, (fays Dr. Thomfon, ) in doubting 

 the veracity of thofe, by whom fimilar inftances of re-uniou 

 between other parts of the body have been related. 



" That praftitioners have generally failed in effefting this 

 re-union, is frankly acknowledged by thofe who have related 

 cafes fo very extraordinary. I (hall mention to you (con- 

 tinues this author) a few of thofe rare cafes, and leave it to 

 your own judgment to deduce from them the conclufions, 

 which the charafters of the authors by whom they are related, 

 and the nature of the fafts themfelves which they relate, may 

 feem to you to warrant. 



" The firft example of this kind which I find diftinftly 

 recorded is by Phiorovant, in the 54th page of his fccond 

 book of the Secrets of Surgery : ' In that time, when I was 

 in Africa, there happened a ftrange affair : a certain gentle- 

 man, a Spaniard, that was called II Signior Andreas Gutierp, 

 of the age of twenty-nine years, upon a time walked in the 

 field, and fell at words with a foldier, and began to draw. 

 The foldier feeing that, ftruck him with the left-hand, and 

 cut off his nofe, and there it fell down in the fand. I then 

 happened to itand by, and took it up, and piffed thereon to 

 wafh away the fand, and dreffed it with our balfamo artifici- 

 ato, and bound it up, and fo left it to remain eight or ten 

 days, thinking that it would have come to matter ; never- 

 thelefs when I did unbind it, I found it faft conglutinated, 

 and then I dreffed it only once more, and he was perfeftly 

 whole, fo that all Naples did wonder thereat, as is well 

 7 known ; 



